Healthcare Provider Details

I. General information

NPI: 1952508848
Provider Name (Legal Business Name): JASON MICHAEL DESADIER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 VAN NESS AVE
FRESNO CA
93721-1128
US

IV. Provider business mailing address

1444 BELMONT PARK RD
OCEANSIDE CA
92057-5727
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 833-963-2082
Mailing address:
  • Phone: 707-334-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A-13739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: