Healthcare Provider Details

I. General information

NPI: 1093839532
Provider Name (Legal Business Name): DEEPTI CHANDRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BAY AVE SUITE B
CAPITOLA CA
95010-2186
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-460-7333
  • Fax:
Mailing address:
  • Phone: 831-458-6603
  • Fax: 831-458-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA102589
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: