Healthcare Provider Details

I. General information

NPI: 1578186458
Provider Name (Legal Business Name): IMMACULATE PRASADANI DESILVA PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STOCKDALE HWY
BAKERSFIELD CA
93311-3632
US

IV. Provider business mailing address

9900 STOCKDALE HWY
BAKERSFIELD CA
93311-3632
US

V. Phone/Fax

Practice location:
  • Phone: 661-282-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number66331
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number028850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: