Healthcare Provider Details

I. General information

NPI: 1487948584
Provider Name (Legal Business Name): DEEPTHI KESANAPALLI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W CHASE AVE
EL CAJON CA
92020-5710
US

IV. Provider business mailing address

13885 CLATSOP WAY
SAN DIEGO CA
92129
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2499
  • Fax:
Mailing address:
  • Phone: 904-962-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA130264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: