MEDICARE: KAVIT A DESOUZA M.D.

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	207RC0000X	Cardiovascular Disease Physician	ME117416	FL
2	207RI0011X	Interventional Cardiology Physician	ME117416	FL
3	207RC0000X	Cardiovascular Disease Physician	A146632	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245441997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVIT A DESOUZA M.D.

Provider Business Mailing Address
First Line	:	19341 BEAR VALLEY RD STE 105
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-247-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	19341 BEAR VALLEY RD STE 105
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-247-6444
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/21/2022

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