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General NPI Number Information
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NPI Number | 1528249802
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Entity Type | Organization
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Legal Business Name | DESILVA MEDICAL, INC.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 623 W AVENUE Q SUITE A
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City | PALMDALE
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State | CA
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Zip | 93551-3890
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Country | US
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Telephone | 661-726-6255
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Fax | 661-726-6261
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Provider Business Mailing Address
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Address Line | PO BOX 4037
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City | LANCASTER
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State | CA
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Zip | 93539-4037
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Country | US
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Telephone | 661-726-6255
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Fax | 661-726-6261
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAMELA D. DESILVA
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Credential | M.D.
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Telephone | 661-726-6255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A48894
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License Number State | CA
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