Provider Demographics
NPI:1306952577
Name:ANVEKAR, ALEXIS M D (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:M D
Last Name:ANVEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BELLEFONTAINE ST
Mailing Address - Street 2:307
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-795-0411
Mailing Address - Fax:626-795-0080
Practice Address - Street 1:50 BELLEFONTAINE ST
Practice Address - Street 2:307
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-795-0411
Practice Address - Fax:626-795-0080
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00233951OtherRAILROAD PROVIDER PIN #
CA00A706550OtherBLUE SHIELD PROV. #
CA05D1055111OtherCLIA LAB WAIVER #
CADD5323OtherRAILROAD GROUP #
CAW18632Medicare ID - Type UnspecifiedGROUP #
CAWA70655BMedicare ID - Type UnspecifiedPROVIDER #
CA00A706550OtherBLUE SHIELD PROV. #