Provider Demographics
NPI:1174542047
Name:ANAGNOS, ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ANAGNOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S MONROE ST
Mailing Address - Street 2:SUITE #40
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5130
Mailing Address - Country:US
Mailing Address - Phone:408-247-5337
Mailing Address - Fax:408-247-9253
Practice Address - Street 1:361 S MONROE ST
Practice Address - Street 2:SUITE #40
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5130
Practice Address - Country:US
Practice Address - Phone:408-247-5337
Practice Address - Fax:408-247-9253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8302702084N0400X
CA00G830272084S0012X, 2084N0600X
CAG830272084N0402X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G830271OtherBLUE SHIELD
CA00G830270OtherBLUE SHIELD
CA00G830271OtherBLUE SHIELD
CA264639036OtherADDITIONAL EIN
CAH53926Medicare UPIN
CA00G830271Medicare ID - Type Unspecified