MEDICARE: NOLAN DESA MD INC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1861356636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLAN DESA MD INC

Provider Business Mailing Address
First Line	:	1666 TUSTIN AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3247
Country	:	US
Telephone Number	:	714-421-1718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 TUSTIN AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3247
Country	:	US
Telephone Number	:	714-421-1718
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NOLAN S DESA
Credential	:	MD
Telephone Number	:	714-421-1718

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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