Healthcare Provider Details

I. General information

NPI: 1942638416
Provider Name (Legal Business Name): ANJALI DSOUZA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 156TH ST NE
MARYSVILLE WA
98271-4831
US

IV. Provider business mailing address

113 CHERRY ST # 39581
SEATTLE WA
98104-2205
US

V. Phone/Fax

Practice location:
  • Phone: 844-202-5555
  • Fax:
Mailing address:
  • Phone: 206-659-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANJALI D'SOUZA
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 206-659-6363