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Individual

ANITHA CHANNABASAVAIAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4501 DALE ROAD, MODESTO, CA 95356
(209) 485-3898
Mailing address
PO BOX 576368, MODESTO, CA 95357-6368
(209) 485-3898

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A83221
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A83221
CA
207RP1001X
Pulmonary Disease Physician
A83221
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
CA
Enumeration date
08/28/2006
Last updated
04/05/2023
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