1235478298 NPI number — ANITA PADMANABHAN KRISHNAN P.T., D.P.T.

Table of content: ANITA PADMANABHAN KRISHNAN P.T., D.P.T. (NPI 1235478298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235478298 NPI number — ANITA PADMANABHAN KRISHNAN P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISHNAN
Provider First Name:
ANITA
Provider Middle Name:
PADMANABHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235478298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26741 PORTOLA PKWY STE 1E-630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOOTHILL RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92610-1743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-597-2103
Provider Business Mailing Address Fax Number:
949-597-2061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 JOURNEY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-716-4548
Provider Business Practice Location Address Fax Number:
949-271-2311
Provider Enumeration Date:
02/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  294621 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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