Individual
BANU KAIZAD ANKLESARIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1086 W ARROW HWY, SAN DIMAS, CA 91773-2492
(909) 305-1352
Mailing address
1620 W BENBOW ST, SAN DIMAS, CA 91773-3413
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
646857
CA
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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