Provider Demographics
NPI:1629122155
Name:DEVGAN, MANJU DIXIT (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJU
Middle Name:DIXIT
Last Name:DEVGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11735 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5917
Mailing Address - Country:US
Mailing Address - Phone:310-390-9829
Mailing Address - Fax:310-391-1290
Practice Address - Street 1:11735 W WASHINGTON BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5917
Practice Address - Country:US
Practice Address - Phone:310-390-9829
Practice Address - Fax:310-391-1290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC38753207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology