Healthcare Provider Details

I. General information

NPI: 1376246868
Provider Name (Legal Business Name): ANAHITA DEYLAMSALEHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

360 S MARKET ST UNIT 1704
SAN JOSE CA
95113-2872
US

V. Phone/Fax

Practice location:
  • Phone: 360-501-3601
  • Fax: 360-501-3648
Mailing address:
  • Phone: 415-815-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.MD.70063572
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: