Healthcare Provider Details

I. General information

NPI: 1700553757
Provider Name (Legal Business Name): DESIREE NICOLE MCINTOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD
SALINAS CA
93906-3144
US

IV. Provider business mailing address

3344 17TH INFANTRY REGIMENT ST
SEASIDE CA
93955-8316
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax:
Mailing address:
  • Phone: 812-229-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: