Healthcare Provider Details

I. General information

NPI: 1083051080
Provider Name (Legal Business Name): ANSON MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MCKEE RD STE 1
SAN JOSE CA
95116-1606
US

IV. Provider business mailing address

2350 MCKEE RD STE 1
SAN JOSE CA
95116-1606
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-3232
  • Fax: 408-729-2165
Mailing address:
  • Phone: 408-729-3232
  • Fax: 408-729-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA045814
License Number StateCA

VIII. Authorized Official

Name: DR. MARIE ANSON-REBONG
Title or Position: OWNER
Credential: MD
Phone: 408-729-3232