Healthcare Provider Details

I. General information

NPI: 1871627463
Provider Name (Legal Business Name): EMIL A ANAYA MD, INC. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE SUITE 104
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

PO BOX 3133
SAN JOSE CA
95156-3133
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-8760
  • Fax: 408-258-8760
Mailing address:
  • Phone: 408-258-8760
  • Fax: 408-258-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA25810
License Number StateCA

VIII. Authorized Official

Name: DR. EMIL ALBERTO ANAYA
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 408-258-8760