Healthcare Provider Details

I. General information

NPI: 1073179529
Provider Name (Legal Business Name): ROSHNI KAKAIYA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 H STREET, CV112
CHULA VISTA CA
91910
US

IV. Provider business mailing address

435 H STREET, CV112
CHULA VISTA CA
91910
US

V. Phone/Fax

Practice location:
  • Phone: 800-727-4777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: