Healthcare Provider Details

I. General information

NPI: 1326156431
Provider Name (Legal Business Name): ANITHA CHANNABASAVAIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 PIRRONE CT
SALIDA CA
95368-9094
US

IV. Provider business mailing address

7601 SPY GLASS DR
MODESTO CA
95356-9583
US

V. Phone/Fax

Practice location:
  • Phone: 209-485-3898
  • Fax:
Mailing address:
  • Phone: 209-485-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA83221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA83221
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA83221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: