=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952336075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANITA M. PAI, M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 BROCKTON AVE STE 2
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92506-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-683-0650
-----------------------------------------------------
Fax | 915-774-4617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1533 SERPENTINE DR
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-6558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-953-0409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANITA M PAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 909-953-0409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | A74144
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------