Healthcare Provider Details

I. General information

NPI: 1578031423
Provider Name (Legal Business Name): SONAM DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 ALONDRA BLVD
PARAMOUNT CA
90723-5200
US

IV. Provider business mailing address

8540 ALONDRA BLVD
PARAMOUNT CA
90723-5200
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-2508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: