Healthcare Provider Details

I. General information

NPI: 1902997687
Provider Name (Legal Business Name): ROBERTO DESDIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 NW 201ST TER
HIALEAH FL
33015-5934
US

IV. Provider business mailing address

PO BOX 934068
MARGATE FL
33093-4068
US

V. Phone/Fax

Practice location:
  • Phone: 305-829-3009
  • Fax:
Mailing address:
  • Phone: 954-366-2700
  • Fax: 954-366-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: