Healthcare Provider Details

I. General information

NPI: 1871718189
Provider Name (Legal Business Name): PUJA CHITKARA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 MEDICAL CENTER CT SUITE 216
CHULA VISTA CA
91911-6600
US

IV. Provider business mailing address

765 MEDICAL CENTER CT SUITE 216
CHULA VISTA CA
91911-6600
US

V. Phone/Fax

Practice location:
  • Phone: 619-623-3000
  • Fax: 619-623-3001
Mailing address:
  • Phone: 619-623-3000
  • Fax: 619-623-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA97619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: