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General NPI Number Information
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NPI Number | 1316963093
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Entity Type | Organization
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Legal Business Name | ANITA STINIVASA MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 S LA FAYETTE PARK PL # 117
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City | LOS ANGELES
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State | CA
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Zip | 90057-3215
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Country | US
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Telephone | 213-382-2630
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Fax | 213-382-2631
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Provider Business Mailing Address
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Address Line | 600 S LA FAYETTE PARK PL # 117
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City | LOS ANGELES
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State | CA
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Zip | 90057-3215
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Country | US
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Telephone | 213-382-2630
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Fax | 213-382-2631
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. ANITA SRINIVASA
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Credential |
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Telephone | 213-382-2630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A66420
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License Number State | CA
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