Individual
ANITA VAIDYANATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12665 VILLAGE LN APT 4507, PLAYA VISTA, CA 90094-2863
(949) 201-9955
Mailing address
12665 VILLAGE LN APT 4507, PLAYA VISTA, CA 90094-2863
(949) 201-9955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
CA
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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