MEDICARE: MRS. PARUL A DESAI RN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	567387	CA
2	363LP2300X	Primary Care Nurse Practitioner	11587	CA

General Provider Information

NPI Number	:	1134577281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PARUL A DESAI RN, NP-C

Provider Business Mailing Address
First Line	:	5800 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036
Country	:	US
Telephone Number	:	310-289-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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