Provider Demographics
NPI:1760576094
Name:DESHPANDE, PRAJAKTA (MD)
Entity Type:Individual
Prefix:
First Name:PRAJAKTA
Middle Name:
Last Name:DESHPANDE
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-573-5261
Mailing Address - Fax:707-573-5414
Practice Address - Street 1:1140 W. LA VETA AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4229
Practice Address - Country:US
Practice Address - Phone:714-547-5404
Practice Address - Fax:714-547-0935
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042638207Q00000X
CAC133444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0224597OtherLABOR AND INDUSTRIES
WA8386849Medicaid
WAI03265Medicare Oscar/Certification
WA0224597OtherLABOR AND INDUSTRIES