Provider Demographics
NPI:1043237597
Name:DESAI, MANOJ SUMANLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:SUMANLAL
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2023 VALE RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3834
Mailing Address - Country:US
Mailing Address - Phone:510-237-3785
Mailing Address - Fax:510-237-2837
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-237-3785
Practice Address - Fax:510-237-2837
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist