Healthcare Provider Details

I. General information

NPI: 1285346742
Provider Name (Legal Business Name): ANITA BAYAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N BROADWAY
SANTA ANA CA
92701-3408
US

IV. Provider business mailing address

1000 S FREMONT AVE BLDG A-11
ALHAMBRA CA
91803-8800
US

V. Phone/Fax

Practice location:
  • Phone: 949-270-2100
  • Fax: 949-650-4458
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: