Healthcare Provider Details

I. General information

NPI: 1154612885
Provider Name (Legal Business Name): ANAND VAIDYANATHAN IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 POTRERO AVE
SAN FRANCISCO CA
94110-2869
US

IV. Provider business mailing address

887 POTRERO AVE
SAN FRANCISCO CA
94110-2869
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-6300
  • Fax:
Mailing address:
  • Phone: 628-206-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA122818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA122818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: