Healthcare Provider Details

I. General information

NPI: 1033846456
Provider Name (Legal Business Name): ANUP MISRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 556-242-0000
  • Fax:
Mailing address:
  • Phone: 559-624-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA205236
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA205236
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA205236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: