Healthcare Provider Details

I. General information

NPI: 1083522957
Provider Name (Legal Business Name): TEJAL DESAI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17259 JASMINE ST STE B
VICTORVILLE CA
92395-7787
US

IV. Provider business mailing address

17259 JASMINE ST STE B
VICTORVILLE CA
92395-7787
US

V. Phone/Fax

Practice location:
  • Phone: 442-414-4198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TEJAL DESAI
Title or Position: RHEUMATOLOGY, PRESIDENT
Credential: MD
Phone: 918-812-3090