Healthcare Provider Details

I. General information

NPI: 1053552893
Provider Name (Legal Business Name): MONISH JATIN LAXPATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 N GAREY AVE
POMONA CA
91767-2139
US

IV. Provider business mailing address

2475 N GAREY AVE
POMONA CA
91767-2139
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-3166
  • Fax: 909-622-8046
Mailing address:
  • Phone: 909-622-3166
  • Fax: 909-622-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA106370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: