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General NPI Number Information
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NPI Number | 1801224092
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Entity Type | Individual
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Provider Name | PRITAL DESAI
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Gender | Female
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 480 TESCONI CIR STE B
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City | SANTA ROSA
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State | CA
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Zip | 95401
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Country | US
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Telephone | 707-206-7268
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Fax | 707-206-7254
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Provider Business Mailing Address
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Address Line | 480 TESCONI CIR STE B
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City | SANTA ROSA
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State | CA
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Zip | 95401-4691
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Country | US
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Telephone | 707-206-7268
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Fax | 707-206-7254
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A150769
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A150768
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License Number State | CA
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