Healthcare Provider Details

I. General information

NPI: 1891437992
Provider Name (Legal Business Name): DARSHI MITESH DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

27000 W LUGONIA AVE APT 8313
REDLANDS CA
92374-2091
US

V. Phone/Fax

Practice location:
  • Phone: 909-475-2612
  • Fax: 909-475-5059
Mailing address:
  • Phone: 813-461-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA198399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: