Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95005288 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95005288 | CA |
NPI | 1508317843 |
---|---|
Provider Name | Miss Anaita Jasmine Panthaky |
First Address | Irvine, CA 92620-1735 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2016 |
Last Update Date | 28/10/2016 |