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NPI Code Detail

MEDICARE: DEEPTI SAMEER MUNDKUR MBBS

MEDICARE: DEEPTI SAMEER MUNDKUR MBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA158230CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A158230OTHERCACA MED LICENSE

General Provider Information

NPI Number : 1629431077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEPTI SAMEER MUNDKUR MBBS
Provider Business Mailing Address
First Line : 15611 POMERADO RD STE 400
Second Line :
City : POWAY
State : CA
Zip : 92064-2437
Country : US
Telephone Number : 858-675-3100
Fax Number :
Provider Business Practice Location Address
First Line : 211 13TH ST
Second Line :
City : RAMONA
State : CA
Zip : 92065-2711
Country : US
Telephone Number : 760-789-5160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2016
Last Update Date : 07/30/2019

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