Provider Demographics
NPI:1497167944
Name:DESAI, ROSHANI (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSHANI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2167
Mailing Address - Country:US
Mailing Address - Phone:310-734-2040
Mailing Address - Fax:310-598-3160
Practice Address - Street 1:700 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2167
Practice Address - Country:US
Practice Address - Phone:310-734-2040
Practice Address - Fax:310-598-3160
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor