Healthcare Provider Details

I. General information

NPI: 1346701398
Provider Name (Legal Business Name): MANSEE PRAGNESH DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E SPRUCE AVE STE 207
FRESNO CA
93720-3390
US

IV. Provider business mailing address

5192 VIA DOLORES
NEWBURY PARK CA
91320-6915
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-7546
  • Fax:
Mailing address:
  • Phone: 805-341-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPTL2979
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number178221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: