Basic Information
| Provider Information | |||||||||
| NPI: | 1235778432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANYASO | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP-C | ||||||||
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| OtherLastName: | ANYASO | ||||||||
| OtherFirstName: | CLARA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2406 SUN SPOT LN | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775843191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812176764 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2242 REPSDORPH RD | ||||||||
| Address2: | |||||||||
| City: | SEABROOK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775866446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814744042 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AP144475 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | AP144475 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.