Healthcare Provider Details

I. General information

NPI: 1922033497
Provider Name (Legal Business Name): ANISE R ADAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 S AUSTIN RD ATTEN: MEDICAL
STOCKON CA
95215
US

IV. Provider business mailing address

7707 S AUSTIN RD ATTEN: MEDICAL
STOCKON CA
95215
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2536
  • Fax: 818-295-6965
Mailing address:
  • Phone: 209-467-2536
  • Fax: 818-242-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: