MEDICARE: MERVAT G. KELADA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A48353	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032437	OTHER	CA	VFC IDENTIFIER
2	28248	OTHER	AZ	ARIZONA LICENSE NUMBER
3	A48353	OTHER	CA	LICENSE NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	13070	OTHER	MI	MISSISSIPPI LICENSE NUMBE
6	ME 62257	OTHER	FL	FLORIDA LICENSE NUMBER
7	00A483531	OTHER	CA	INSURANCE
8	330742343	OTHER	CA	E.I.N. NUMBER
9	05D0906507	OTHER	CA	CLIA ID NUMBER

General Provider Information

NPI Number	:	1255333035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERVAT G. KELADA M.D.

Provider Business Mailing Address
First Line	:	1001 BLAIR AVE
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231
Country	:	US
Telephone Number	:	760-768-5055
Fax Number	:	760-768-5037

Provider Business Practice Location Address
First Line	:	1001 BLAIR AVE
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231
Country	:	US
Telephone Number	:	760-768-5055
Fax Number	:	760-768-5037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/07/2023

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Directions to “ MERVAT G. KELADA M.D.” Practice Location

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