Basic Information
| Provider Information | |||||||||
| NPI: | 1649358185 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LOU | ||||||||
| FirstName: | ANNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1017 EL CAMINO REAL | ||||||||
| Address2: | PMB 285 | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258204230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 YGNACIO VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259393000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A50039 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 00A500390 | 05 | CA | MEDICAID |