Healthcare Provider Details

I. General information

NPI: 1548379464
Provider Name (Legal Business Name): SHRILEKHA CHAMPANERI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-6546
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA46667
License Number StateCA

VIII. Authorized Official

Name: DR. SHRILEKHA CHAMPANERI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243