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General NPI Number Information
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NPI Number | 1487642377
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Entity Type | Individual
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Provider Name | SANJAY VIJAY DESHMUKH M. D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1625 E 17TH ST STE. 100
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City | SANTA ANA
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State | CA
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Zip | 92705-8517
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Country | US
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Telephone | 714-543-9555
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Fax | 714-543-9595
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Provider Business Mailing Address
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Address Line | 1625 E 17TH ST STE. 100
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City | SANTA ANA
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State | CA
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Zip | 92705-8517
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Country | US
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Telephone | 714-543-9555
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Fax | 714-543-9595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A65424
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License Number State | CA
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