Healthcare Provider Details

I. General information

NPI: 1386324473
Provider Name (Legal Business Name): DEEPAK P MAHARAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

IV. Provider business mailing address

3501 HARBISON DR UNIT 1005
VACAVILLE CA
95687-3934
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3000
  • Fax:
Mailing address:
  • Phone: 650-771-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNA
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: