Healthcare Provider Details

I. General information

NPI: 1174542047
Provider Name (Legal Business Name): ANGELA ANAGNOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 S MONROE ST SUITE #40
SAN JOSE CA
95128-5130
US

IV. Provider business mailing address

361 S MONROE ST SUITE #40
SAN JOSE CA
95128-5130
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-5337
  • Fax: 408-247-9253
Mailing address:
  • Phone: 408-247-5337
  • Fax: 408-247-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG830270
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number00G83027
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number00G83027
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberG83027
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberG83027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: