Healthcare Provider Details

I. General information

NPI: 1437543022
Provider Name (Legal Business Name): ANTHONY KULETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 PARK BLVD STE 204
SAN DIEGO CA
92116-4039
US

IV. Provider business mailing address

4452 PARK BLVD STE 204
SAN DIEGO CA
92116-4039
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-1382
  • Fax: 888-618-3258
Mailing address:
  • Phone: 619-823-1382
  • Fax: 888-618-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA146804
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA146804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: