Healthcare Provider Details

I. General information

NPI: 1629393459
Provider Name (Legal Business Name): AJIT DEOL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

PO BOX 7668
MISSION HILLS CA
91346-7668
US

V. Phone/Fax

Practice location:
  • Phone: 661-287-3162
  • Fax: 661-287-3951
Mailing address:
  • Phone: 661-287-3162
  • Fax: 661-287-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA73499
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA73499
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AJIT S DEOL
Title or Position: PRESIDENT
Credential: MD
Phone: 661-287-3162