Provider Demographics
NPI:1477160588
Name:DEOGUN, SANDEEP (CRNA)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:DEOGUN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14463 DUSTY COYOTE AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5759
Mailing Address - Country:US
Mailing Address - Phone:951-489-8295
Mailing Address - Fax:
Practice Address - Street 1:14463 DUSTY COYOTE AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5759
Practice Address - Country:US
Practice Address - Phone:951-489-8295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95069443163W00000X
CA95001508367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse