Healthcare Provider Details

I. General information

NPI: 1790708998
Provider Name (Legal Business Name): ANIL CHAWLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S WELLS RD SUITE 100
VENTURA CA
93004
US

IV. Provider business mailing address

200 S WELLS RD SUITE 200
VENTURA CA
93004-1377
US

V. Phone/Fax

Practice location:
  • Phone: 805-659-1740
  • Fax: 805-659-9959
Mailing address:
  • Phone: 805-659-1740
  • Fax: 805-659-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA41276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: