Healthcare Provider Details

I. General information

NPI: 1467847236
Provider Name (Legal Business Name): KANWARDEEP SINGH KALEKA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date: 02/25/2021
Reactivation Date: 04/07/2021

III. Provider practice location address

1328 S MISSION RD # 8809
FALLBROOK CA
92028-4006
US

IV. Provider business mailing address

200 W ARBOR DR #8809
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 760-451-4770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA147353
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA147353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: