OrganizationKesanapalli Pediatrics Professional Medical Corporation(<Unavail>)PediatricsAllopathic & Osteopathic PhysiciansPractice Address7910 Frost Street, Suite 335, San Diego, CA 92123-2771(858) 576-8010PECOS EnrollmentBased on the most recent information from CMS, provider Kesanapalli Pediatrics Professional Medical Corporation does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:29 PM.Profile DetailsProvider ID1780841841Provider TypeOrganizationFull NameKesanapalli Pediatrics Professional Medical CorporationOther Name<Unavail>SubpartNoEnumeration Date5/16/2008Last Updated9/13/2024Contact InformationPractice LocationPractice Address7910 Frost Street, Suite 335, San Diego, CA 92123-2771Phone(858) 576-8010Fax(858) 576-7391Mailing LocationMailing Address7910 Frost Street, Suite 335, San Diego, CA 92123-2771Phone(858) 576-8010Fax(858) 576-7391Authorized OfficialNameKesanapalli, Deepthi (Ceo)Phone(858) 576-8010Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseA56064CaliforniaProvider IdentifiersIDDescriptionIssuerIDA560640DescriptionMedicaidIssuerUnlistedCaliforniaIDZZZ01416ZDescriptionOtherIssuerBLUE SHIELDCalifornia