Provider Demographics
NPI:1518904077
Name:AWASTHI, SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:AWASTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 S. MAYFLOWER AVENUE
Mailing Address - Street 2:2ND FL
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5266
Mailing Address - Country:US
Mailing Address - Phone:626-775-3514
Mailing Address - Fax:626-408-3911
Practice Address - Street 1:1500 E. DUARTE RD.
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3000
Practice Address - Country:US
Practice Address - Phone:626-256-4673
Practice Address - Fax:626-471-9373
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7117207RX0202X
CAC54833207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138510606Medicaid
TX138510613Medicaid
OK100163170AMedicaid
TX138510607Medicaid
TX8R1390OtherBLUE CROSS OF TEXAS
TX900002397Medicare PIN
TX138510613Medicaid
TX8799M7Medicare PIN
TX8C1260Medicare PIN