1629393459 NPI number — AJIT DEOL MD INC

Table of content: (NPI 1629393459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629393459 NPI number — AJIT DEOL MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AJIT DEOL MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629393459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91346-7668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-287-3162
Provider Business Mailing Address Fax Number:
661-287-3951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15031 RINALDI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-287-3162
Provider Business Practice Location Address Fax Number:
661-287-3951
Provider Enumeration Date:
04/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEOL
Authorized Official First Name:
AJIT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-287-3162

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0102X , with the licence number: A73499 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: A73499 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)