| Dean M Kelaita M D Medical | |
|
900 Mountain Ranch Rd San Andreas CA 95249-9713 | |
| (209) 483-4760 | |
| Not Available |
| Full Name | Dean M Kelaita M D Medical |
|---|---|
| Speciality | Internal Medicine |
| Location | 900 Mountain Ranch Rd, San Andreas, California |
| Authorized Official Name and Position | Dean M Kelaita (CEO) |
| Authorized Official Contact | 2094834760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dean M Kelaita M D Medical Po Box 30 Mokelumne Hill CA 95245-0030 Ph: (209) 483-4760 | Dean M Kelaita M D Medical 900 Mountain Ranch Rd San Andreas CA 95249-9713 Ph: (209) 483-4760 |
| NPI Number | 1548930803 |
|---|---|
| Provider Enumeration Date | 09/17/2021 |
| Last Update Date | 10/18/2021 |
| Medicare PECOS PAC ID | 5395133391 |
|---|---|
| Medicare Enrollment ID | O20211025001239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548930803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Dean M Kelaita |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750310496 PECOS PAC ID: 5092791541 Enrollment ID: I20040625000955 |
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