Healthcare Provider Details

I. General information

NPI: 1932810710
Provider Name (Legal Business Name): DEEPTI KEDARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E RAMSEY DR
MOUNTAIN HOUSE CA
95391-8812
US

IV. Provider business mailing address

173 E RAMSEY DR
MOUNTAIN HOUSE CA
95391-8812
US

V. Phone/Fax

Practice location:
  • Phone: 323-202-6047
  • Fax:
Mailing address:
  • Phone: 323-202-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: