Individual provider Active NPI

Deslin Thomas, M.D

  • Family Medicine Physician
  • Diamond Bar, CA
National Provider Identifier
1679757124
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A110241 Issued in CA
Practice address
21015 Pathfinder Rd Ste 200
Diamond Bar, CA 91765-4002
Phone
(323) 804-5824
NPI assigned
Dec 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A110241 CA Primary

Addresses

Primary practice location

21015 Pathfinder Rd Ste 200
Diamond Bar, CA 91765-4002

Mailing address

16756 Chino Corona Rd
Corona, CA 92880
Phone (909) 287-1709

Other names 1

  • Dr. Deslin Varghese Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101109001084 CA Practitioner - Family Practice 1355536988 Reassigns benefits to 2 organizations
I20221221003214 FL Practitioner - Family PracticePractitioner - Addiction Medicine 1355536988

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
110241CAMDClinical Social Worker
A110241CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Live Life Now Health Group PA Family Medicine CurrentSince Nov 1, 2022 Accepting new patients
Chino Medical Group, Inc Family Medicine CurrentSince Jan 4, 2017 Accepting new patients
Live Life Now Health Group of California PC CurrentSince Nov 1, 2022 Accepting new patients

Locations

5475 Walnut Ave
Chino, CA 91710
Phone (909) 591-6446

5800 S Eastern Ave
Ste 500
Commerce, CA 90040
Phone (323) 308-9397

350 7th Ave
Rm 600
New York, NY 10001

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1679757124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16756 CHINO CORONA RD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "92880",
            "telephone_number": "909-287-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21015 PATHFINDER RD STE 200",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654002",
            "telephone_number": "323-804-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "DESLIN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-19",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A110241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESLIN",
            "last_name": "VARGHESE",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Diamond Bar, CA

Sources for this page

Verify at the official NPI Registry.