Healthcare Provider Details

I. General information

NPI: 1235369968
Provider Name (Legal Business Name): SHILPA DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE 5TH FLOOR
LOS ANGELES CA
90027-5337
US

IV. Provider business mailing address

1515 N VERMONT AVE 5TH FLOOR
LOS ANGELES CA
90027-5337
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4652
  • Fax:
Mailing address:
  • Phone: 323-783-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT195556
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA125863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: