Provider Demographics
NPI:1487948584
Name:KESANAPALLI, DEEPTHI (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:
Last Name:KESANAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13885 CLATSOP WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:904-962-6763
Mailing Address - Fax:
Practice Address - Street 1:1111 W CHASE AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5710
Practice Address - Country:US
Practice Address - Phone:619-515-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130264208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty