Healthcare Provider Details

I. General information

NPI: 1588058721
Provider Name (Legal Business Name): ANNA T DO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 3RD AVE
SAN DIEGO CA
92103-3002
US

IV. Provider business mailing address

3939 3RD AVE
SAN DIEGO CA
92103-3002
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-2737
  • Fax:
Mailing address:
  • Phone: 800-765-2737
  • Fax: 619-291-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number285635
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA172035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: