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General NPI Number Information
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NPI Number | 1194776740
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Entity Type | Individual
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Provider Name | LUIS RAFAEL DESOUZA M.D., PH.D, M.P.H
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 2001 ZINFANDEL DR SUITE A-1
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-859-9934
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Fax | 916-859-9994
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Provider Business Mailing Address
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Address Line | 2001 ZINFANDEL DR SUITE A-1
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-859-9934
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Fax | 916-859-9994
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | A41238
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A41238
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License Number State | CA
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