Healthcare Provider Details

I. General information

NPI: 1518420785
Provider Name (Legal Business Name): NIKHITHA CHANDRASHEKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CITRACADO PKWY STE 108
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 CITRACADO PKWY STE 108
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-1431
  • Fax: 760-743-6455
Mailing address:
  • Phone: 760-743-1431
  • Fax: 760-743-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberTP348
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: