Provider Demographics
NPI:1699960534
Name:DAVID, ANJALI ROBIN (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:ROBIN
Last Name:DAVID
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26338 TUDOR COURT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:909-657-9082
Mailing Address - Fax:
Practice Address - Street 1:1717 W STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545
Practice Address - Country:US
Practice Address - Phone:951-925-9171
Practice Address - Fax:951-925-8186
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner