Provider Demographics
NPI:1134368582
Name:ANITA S PAKULA MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANITA S PAKULA MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-338-7094
Mailing Address - Street 1:29501 CANWOOD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1558
Mailing Address - Country:US
Mailing Address - Phone:818-338-7094
Mailing Address - Fax:818-338-7099
Practice Address - Street 1:29501 CANWOOD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:805-373-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty