Individual
KELAN G. TANTISIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MPH
Contact information
Practice address
3030 CHILDRENS WAY, SAN DIEGO, CA 92123-4232
(858) 966-5846
Mailing address
3020 CHILDRENS WAY # MC5003, SAN DIEGO, CA 92123-4223
(858) 309-6300
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
155411
MA
207RP1001X
Pulmonary Disease Physician
Primary
G67143
CA
208000000X
Pediatrics Physician
G67143
CA
Other
Enumeration date
06/03/2006
Last updated
01/07/2021
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