Healthcare Provider Details

I. General information

NPI: 1679757124
Provider Name (Legal Business Name): DESLIN THOMAS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DESLIN VARGHESE M.D

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21015 PATHFINDER RD STE 200
DIAMOND BAR CA
91765-4002
US

IV. Provider business mailing address

16756 CHINO CORONA RD
CORONA CA
92880
US

V. Phone/Fax

Practice location:
  • Phone: 323-804-5824
  • Fax:
Mailing address:
  • Phone: 909-287-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA110241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: