Healthcare Provider Details

I. General information

NPI: 1407297005
Provider Name (Legal Business Name): AMAR ANAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLEN COVE MARINA RD E
VALLEJO CA
94591-7284
US

IV. Provider business mailing address

712 BANCROFT RD STE 905
WALNUT CREEK CA
94598-1531
US

V. Phone/Fax

Practice location:
  • Phone: 707-980-6257
  • Fax: 707-980-6692
Mailing address:
  • Phone: 707-980-6257
  • Fax: 707-980-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number01080969A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberA149857
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01080969A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL36095
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA149857
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA149857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: