Individual provider · NPI-1

Mark Anantiyo

Psychiatry & Neurology, Psychiatry · Pomona, CA

NPI number1245958453
StatusActive
Last updated in NPPESMay 1, 2023

Details

NPI
1245958453
Entity type
Individual (NPI-1)
Name
Mark Anantiyo
Sex
Male
Sole proprietor
No
Enumeration date
Aug 15, 2022
Certification date
May 1, 2023
Last updated
May 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084P0800X Psychiatry & Neurology, PsychiatryPA61663CAYes
363A00000X Physician Assistant––

Practice location

309 E 2nd St
Pomona, CA 91766-1854

Phone 909-623-6111

Mailing address

7617 E Hollow Oak Rd
Anaheim, CA 92808-1426

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Psychiatry & Neurology, Psychiatry providers in Pomona, CA