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General NPI Number Information
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NPI Number | 1700327921
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Entity Type | Individual
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Provider Name | LAURA DECESARE MD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 4150 REGENTS PARK ROW STE 345
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-207-3117
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Fax | 858-240-4029
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Provider Business Mailing Address
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Address Line | 28078 BAXTER RD STE 530
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City | MURRIETA
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State | CA
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Zip | 92563-1405
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Country | US
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Telephone | 858-207-3117
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125070479
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A196464
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License Number State | CA
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