Healthcare Provider Details

I. General information

NPI: 1659371748
Provider Name (Legal Business Name): JEFFREY R DESANTIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JEFFREY R DESANTIS DPM

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 E CHAPMAN AVE
ORANGE CA
92866-2111
US

IV. Provider business mailing address

1038 E CHAPMAN AVE
ORANGE CA
92866-2111
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-4191
  • Fax: 714-771-2731
Mailing address:
  • Phone: 714-771-4191
  • Fax: 714-771-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: