MEDICARE: MRS. DESIREE MARIE SAYLOR HARGUESS D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	PT294140	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT294140	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1437658390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESIREE MARIE SAYLOR HARGUESS D.P.T.

Provider Business Mailing Address
First Line	:	3145 ROSECRANS ST STE F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4831
Country	:	US
Telephone Number	:	619-223-7175
Fax Number	:	619-223-7030

Provider Business Practice Location Address
First Line	:	3450 BONITA RD STE 105
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3249
Country	:	US
Telephone Number	:	619-425-1084
Fax Number	:	619-425-1084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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