Provider Demographics
NPI:1316117682
Name:ANAYA, LAURA HEATHER (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:HEATHER
Last Name:ANAYA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 PACHECO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2309
Mailing Address - Country:US
Mailing Address - Phone:925-676-0505
Mailing Address - Fax:925-676-2814
Practice Address - Street 1:200 PORTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1587
Practice Address - Country:US
Practice Address - Phone:925-838-2108
Practice Address - Fax:925-838-9265
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant