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Individual

CALEB FANEN ICHULL-INGYA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
8775 AERO DR STE 132, SAN DIEGO, CA 92123-1779
(858) 609-8742
Mailing address
8775 AERO DR STE 132, SAN DIEGO, CA 92123-1779
(562) 414-9764

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CA
175T00000X
Peer Specialist

Other

Enumeration date
02/09/2022
Last updated
03/27/2023
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