Healthcare Provider Details

I. General information

NPI: 1013120120
Provider Name (Legal Business Name): MONICA SUDHIR DESHMUKH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 OCEAN FRONT WALK APT 415
SANTA MONICA CA
90401-3100
US

IV. Provider business mailing address

14445 OLIVE VIEW DR DEPT
SYLMAR CA
91342-1438
US

V. Phone/Fax

Practice location:
  • Phone: 609-313-4191
  • Fax:
Mailing address:
  • Phone: 609-313-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA100264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: