Provider Demographics
NPI:1124159173
Name:ANIC, SVETLANA (MD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:ANIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:ANIC-LABAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:206 BELOIT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3010
Mailing Address - Country:US
Mailing Address - Phone:818-574-8737
Mailing Address - Fax:310-933-0283
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:559-934-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA723492084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72349OtherMEDICAL BOARD OF CALIFORNIA, PHYSICIAN AND SURGEON