Healthcare Provider Details

I. General information

NPI: 1679120836
Provider Name (Legal Business Name): ANTHONY KELADA PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 RESERVE DR STE B
ROSEVILLE CA
95678-1350
US

IV. Provider business mailing address

991 RESERVE DR STE B
ROSEVILLE CA
95678-1350
US

V. Phone/Fax

Practice location:
  • Phone: 916-789-8811
  • Fax: 916-789-8809
Mailing address:
  • Phone: 916-789-8811
  • Fax: 916-789-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY KELADA
Title or Position: PRESIDENT
Credential: MD
Phone: 916-218-2277