Healthcare Provider Details

I. General information

NPI: 1790292100
Provider Name (Legal Business Name): ANNA BARMINOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR STE 3
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

5249 COLODNY DR UNIT 8
AGOURA HILLS CA
91301-2637
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7760
  • Fax:
Mailing address:
  • Phone: 805-334-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA167612
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME160110
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME160110
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61579822
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD221781
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: