Healthcare Provider Details

I. General information

NPI: 1174901128
Provider Name (Legal Business Name): DAVID DESAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NEVADA ST STE 101
REDLANDS CA
92374-2957
US

IV. Provider business mailing address

1030 NEVADA ST STE 101
REDLANDS CA
92374-2957
US

V. Phone/Fax

Practice location:
  • Phone: 909-966-5500
  • Fax: 909-966-5222
Mailing address:
  • Phone: 909-966-5500
  • Fax: 909-966-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA1004997
License Number StateCA

VIII. Authorized Official

Name: DAVID DESAI
Title or Position: OWNER
Credential: MD
Phone: 951-530-3294