Provider Demographics
NPI:1548562671
Name:DESAI, ROSHNI BALKRISHNA (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSHNI
Middle Name:BALKRISHNA
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14777 LOS GATOS BLVD
Mailing Address - Street 2:SUIT 105
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2059
Mailing Address - Country:US
Mailing Address - Phone:408-340-5120
Mailing Address - Fax:650-421-7494
Practice Address - Street 1:14777 LOS GATOS BLVD
Practice Address - Street 2:SUIT 105
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2059
Practice Address - Country:US
Practice Address - Phone:408-340-5120
Practice Address - Fax:650-421-7494
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant