Provider Demographics
NPI:1851337034
Name:DESHMUKH, SUBHASH B (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:B
Last Name:DESHMUKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:STE 2H
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-735-7200
Mailing Address - Fax:951-735-2571
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:STE 2H
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-735-7200
Practice Address - Fax:951-735-2571
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A424900Medicaid
CA00A424900Medicaid
CA00A424900Medicare ID - Type Unspecified