Provider Demographics
NPI:1083687891
Name:DESANTO, JOSEPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:DESANTO
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 1:230 E 17TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3824
Mailing Address - Country:US
Mailing Address - Phone:949-734-0114
Mailing Address - Fax:949-220-0061
Practice Address - Street 1:230 E 17TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3824
Practice Address - Country:US
Practice Address - Phone:949-734-0114
Practice Address - Fax:949-220-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG081151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine