Individual
JEREMY K. DEISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11234 ANDERSON ST, ROOM 2151, LOMA LINDA, CA 92354-2804
(909) 558-5170
Mailing address
PO BOX 1740, LOMA LINDA, CA 92354-0240
(909) 558-5170
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
A117116
CA
207ZP0101X
Anatomic Pathology Physician
Primary
A117116
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A117116
CALIFORNIA MEDICAL LICENSE
CA
Enumeration date
06/09/2007
Last updated
07/06/2011
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