Healthcare Provider Details

I. General information

NPI: 1265203558
Provider Name (Legal Business Name): SUSHIL ANAND & ASSOCIATES MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13372 NEWPORT AVE STE B
TUSTIN CA
92780-3426
US

IV. Provider business mailing address

13372 NEWPORT AVE STE B
TUSTIN CA
92780-3426
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-3430
  • Fax: 714-573-8330
Mailing address:
  • Phone: 714-544-3430
  • Fax: 714-573-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PREM ANAND
Title or Position: CFO
Credential:
Phone: 909-682-0069