Provider Demographics
NPI:1437339637
Name:DESAI, ANGELA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28541 KALMIA AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6521
Mailing Address - Country:US
Mailing Address - Phone:951-538-8508
Mailing Address - Fax:
Practice Address - Street 1:1673 W BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1109
Practice Address - Country:US
Practice Address - Phone:714-774-5915
Practice Address - Fax:714-774-8095
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA475289OtherLICENSE
CA475289OtherLICENSE