Healthcare Provider Details

I. General information

NPI: 1043257066
Provider Name (Legal Business Name): KEERTI GURUSHANTHAIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 GENESEE AVE SUITE 220
SAN DIEGO CA
92121-2121
US

IV. Provider business mailing address

9339 GENESEE AVE SUITE 220
SAN DIEGO CA
92121-2121
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-7520
  • Fax: 858-554-1312
Mailing address:
  • Phone: 858-455-7520
  • Fax: 858-554-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA68300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: