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General NPI Number Information
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NPI Number | 1922256411
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Entity Type | Individual
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Provider Name | NINA DESAI M.D
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 06/22/2020
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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 | 310-844-0828
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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 |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 254065-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 111867
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License Number State | CA
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