Provider Demographics
NPI:1538106307
Name:DEUTSCH, JASON H (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:H
Last Name:DEUTSCH
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:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:800-236-4469
Mailing Address - Fax:805-375-8903
Practice Address - Street 1:3630 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2636
Practice Address - Country:US
Practice Address - Phone:310-900-2768
Practice Address - Fax:310-900-8852
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG830312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G830310OtherBLUE SHIELD OF CA
CA00G830310Medicaid
CAWG83031AMedicare PIN
CAWG83031QMedicare PIN
CA00G830310OtherBLUE SHIELD OF CA
CAWG83031PMedicare PIN
G11647Medicare UPIN
CAWG83031MMedicare PIN