Healthcare Provider Details

I. General information

NPI: 1023210473
Provider Name (Legal Business Name): DESI ELPIDIO BARROGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 GREENVILLE AVE STE 700
DALLAS TX
75231-3822
US

IV. Provider business mailing address

91-1666 AUWAHA ST
EWA BEACH HI
96706-1814
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-7881
  • Fax: 214-369-7882
Mailing address:
  • Phone: 818-220-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM5042
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: