Individual
ANITA SIVASUBRAMANIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7215 N FRESNO ST, SUITE 102, FRESNO, CA 93720-2969
(559) 446-0409
(559) 446-0903
Mailing address
7489 N 1ST ST, STE 103, FRESNO, CA 93720-2848
(559) 446-0409
(559) 446-0903
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A74387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A743870
—
CA
Enumeration date
08/09/2006
Last updated
01/22/2017
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