Healthcare Provider Details

I. General information

NPI: 1710371281
Provider Name (Legal Business Name): ANITA D KAPUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S SAN MATEO DR
SAN MATEO CA
94401-3857
US

IV. Provider business mailing address

50 S SAN MATEO DR
SAN MATEO CA
94401-3857
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8720
  • Fax:
Mailing address:
  • Phone: 650-652-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA143745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: