Provider Demographics
NPI:1548444250
Name:ANAND, SUSHIL PRABAKARAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:PRABAKARAN
Last Name:ANAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W F ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3206
Mailing Address - Country:US
Mailing Address - Phone:909-983-4746
Mailing Address - Fax:909-983-9766
Practice Address - Street 1:304 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3206
Practice Address - Country:US
Practice Address - Phone:909-983-4746
Practice Address - Fax:909-983-9766
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110593208000000X, 208000000X
NV13978208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13978OtherLICENSE
CAA110593OtherCALIFORNIA MEDICAL BOARD
FP1785293OtherFEDERAL DEA