Healthcare Provider Details

I. General information

NPI: 1205930377
Provider Name (Legal Business Name): MUKUND DESHMUKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BROCKTON AVE SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
RIVERSIDE CA
92506-1862
US

IV. Provider business mailing address

PO BOX 2089 SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
ARTESIA CA
90702-2089
US

V. Phone/Fax

Practice location:
  • Phone: 951-275-8500
  • Fax: 951-275-8560
Mailing address:
  • Phone: 951-926-1014
  • Fax: 951-926-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA51789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: