Provider Demographics
NPI:1649245879
Name:DESAI, MADHURI ADESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHURI
Middle Name:ADESH
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12021 DORAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1439
Mailing Address - Country:US
Mailing Address - Phone:818-360-8854
Mailing Address - Fax:818-831-6511
Practice Address - Street 1:11600 INDIAN HILLS RD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1225
Practice Address - Country:US
Practice Address - Phone:818-838-4547
Practice Address - Fax:818-838-7520
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAA72378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH88165Medicare UPIN