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General NPI Number Information
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NPI Number | 1447309554
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Entity Type | Organization
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Legal Business Name | ANANDA INSTITUTE
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 401 S A ST
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City | SANTA ROSA
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State | CA
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Zip | 95401-8518
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Country | US
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Telephone | 707-544-4441
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Fax | 707-544-4492
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Provider Business Mailing Address
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Address Line | 401 S A ST
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City | SANTA ROSA
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State | CA
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Zip | 95401-8518
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Country | US
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Telephone | 707-544-4441
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Fax | 707-544-4492
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MICHAEL ANTHONY FRAGA
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Credential | PSY.D
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Telephone | 707-544-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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