Healthcare Provider Details

I. General information

NPI: 1932235587
Provider Name (Legal Business Name): PRITI NIMESH DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N 3RD AVE SUITE 205
COVINA CA
91723-1905
US

IV. Provider business mailing address

315 N 3RD AVE SUITE 205
COVINA CA
91723-1905
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-4543
  • Fax: 626-332-2228
Mailing address:
  • Phone: 626-332-4543
  • Fax: 626-332-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA80894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: