Provider Demographics
NPI:1669494118
Name:SAXENA, DEEPTI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:SAXENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43628 SKYE RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5925
Mailing Address - Country:US
Mailing Address - Phone:510-229-9738
Mailing Address - Fax:510-266-1515
Practice Address - Street 1:39210 STATE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1456
Practice Address - Country:US
Practice Address - Phone:510-790-2144
Practice Address - Fax:510-266-1515
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A813820OtherBLUE SHIELD OF CA PIN
CA00A813820Medicaid
CA00A813820Medicare PIN
H53416Medicare UPIN