Healthcare Provider Details

I. General information

NPI: 1174901060
Provider Name (Legal Business Name): KAVYA H MANU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8425
SAN DIEGO CA
92103
US

IV. Provider business mailing address

200 W ARBOR DR # 8425
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6268
  • Fax: 619-543-6528
Mailing address:
  • Phone: 619-543-6268
  • Fax: 619-543-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA144220
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA144220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: