Healthcare Provider Details

I. General information

NPI: 1528249802
Provider Name (Legal Business Name): DESILVA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W AVENUE Q SUITE A
PALMDALE CA
93551-3890
US

IV. Provider business mailing address

PO BOX 4037
LANCASTER CA
93539-4037
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-6255
  • Fax: 661-726-6261
Mailing address:
  • Phone: 661-726-6255
  • Fax: 661-726-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48894
License Number StateCA

VIII. Authorized Official

Name: DR. PAMELA D. DESILVA
Title or Position: OWNER
Credential: M.D.
Phone: 661-726-6255