Organization
JAAGMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA ANAGNOS M.D. (PRESIDENT)
(408) 378-4434
Entity
Organization
Contact information
Practice address
1309 S MARY AVE, SUITE NUMBER 135, SUNNYVALE, CA 94087-3050
(408) 245-1300
(408) 245-1305
Mailing address
94 AMATO AVE, CAMPBELL, CA 95008-1805
(408) 378-4434
(408) 245-1305
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
G830270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G830270
BLUE SHIELD
CA
01
—
00G830271
BLUE SHIELD
CA
Enumeration date
07/20/2006
Last updated
08/22/2020
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