Healthcare Provider Details

I. General information

NPI: 1477871473
Provider Name (Legal Business Name): DURGA SHRIKANT DESHPANDE M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD CHILDRENS HOSPITAL OF LOS ANGELES
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4650 W SUNSET BLVD CHILDRENS HOSPITAL OF LOS ANGELES
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-4575
  • Fax:
Mailing address:
  • Phone: 323-361-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0037535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: