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General NPI Number Information
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NPI Number | 1629692264
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Entity Type | Organization
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Legal Business Name | NINA DESAI M.D., INC.
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 1000 N SEPULVEDA BLVD STE 250
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5975
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Country | US
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Telephone | 310-944-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 PALM AVE
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2639
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Country | US
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Telephone | 310-944-0244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NINA DESAI
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Credential | MD
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Telephone | 310-944-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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