Provider Demographics
NPI:1306286661
Name:PERUMATTAM, ANU C (NP)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:C
Last Name:PERUMATTAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANU
Other - Middle Name:V
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 W HEDDING ST
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-1706
Mailing Address - Country:US
Mailing Address - Phone:408-230-1410
Mailing Address - Fax:
Practice Address - Street 1:150 W HEDDING ST
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1706
Practice Address - Country:US
Practice Address - Phone:408-230-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21834363LP0808X
CA3776364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult