Basic Information
| Provider Information | |||||||||
| NPI: | 1811973092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRISHNAMURTHY | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 TREAT BLVD # 300 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522828 | ||||||||
| FaxNumber: | 9259522850 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 BROOKWOOD RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ORINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945633042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252549090 | ||||||||
| FaxNumber: | 9252544399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A92332 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A923320 | 05 | CA | MEDICAID | P01568518 | 01 | CA | RAILROAD MEDICARE | OTHER |