Healthcare Provider Details

I. General information

NPI: 1649651563
Provider Name (Legal Business Name): CHITRA SAFAYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

11835 CARMEL MOUNTAIN RD STE 1304-167
SAN DIEGO CA
92128-4609
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-6000
  • Fax:
Mailing address:
  • Phone: 702-625-9615
  • Fax: 702-441-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA123589
License Number StateCA

VIII. Authorized Official

Name: DR. CHITRA SAFAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 702-625-9615