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General NPI Number Information
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NPI Number | 1649245879
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Entity Type | Individual
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Provider Name | MADHURI ADESH DESAI M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 11600 INDIAN HILLS RD
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City | MISSION HILLS
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State | CA
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Zip | 91345-1225
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Country | US
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Telephone | 818-838-4547
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Fax | 818-838-7520
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Provider Business Mailing Address
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Address Line | 12021 DORAL AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91326-1439
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Country | US
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Telephone | 818-360-8854
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Fax | 818-831-6511
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A72378
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License Number State | CA
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