Provider Demographics
NPI:1013120120
Name:DESHMUKH, MONICA SUDHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:SUDHIR
Last Name:DESHMUKH
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 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:DEPT RADIOLOGY 2D115
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1438
Mailing Address - Country:US
Mailing Address - Phone:609-313-4191
Mailing Address - Fax:
Practice Address - Street 1:1725 OCEAN FRONT WALK
Practice Address - Street 2:APT 415
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3100
Practice Address - Country:US
Practice Address - Phone:609-313-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1002642085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program