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NPI Code Detail

MEDICARE: DESIREE ODOM MS

MEDICARE: DESIREE ODOM MS
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
1103TP0814XPsychoanalysis PsychologistCA
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1720116460
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE ODOM MS
Provider Business Mailing Address
First Line : 1145 BRIANNA AVE
Second Line :
City : LANCASTER
State : CA
Zip : 93535-2931
Country : US
Telephone Number : 323-401-7870
Fax Number :
Provider Business Practice Location Address
First Line : 1721 GRIFFIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3312
Country : US
Telephone Number : 323-221-4134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 01/23/2026

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