Healthcare Provider Details

I. General information

NPI: 1639411093
Provider Name (Legal Business Name): ANGEL N DESAI M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE G500
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE G500
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-3299
  • Fax:
Mailing address:
  • Phone: 916-443-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberML60363563
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number275440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: