Provider Demographics
NPI:1205930377
Name:DESHMUKH, MUKUND (MD)
Entity type:Individual
Prefix:
First Name:MUKUND
Middle Name:
Last Name:DESHMUKH
Suffix:
Gender:M
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:PO BOX 2089
Mailing Address - Street 2:SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-2089
Mailing Address - Country:US
Mailing Address - Phone:951-926-1014
Mailing Address - Fax:951-926-1014
Practice Address - Street 1:5900 BROCKTON AVE
Practice Address - Street 2:SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1862
Practice Address - Country:US
Practice Address - Phone:951-275-8500
Practice Address - Fax:951-275-8560
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA517892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A517890Medicare ID - Type Unspecified
F52341Medicare UPIN