Provider Demographics
NPI:1790714772
Name:DESIR, CARLOS JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:DESIR
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CERRITO BAJO LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2055
Mailing Address - Country:US
Mailing Address - Phone:915-526-6280
Mailing Address - Fax:
Practice Address - Street 1:4800 ALBERTA AVE
Practice Address - Street 2:STE. 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2709
Practice Address - Country:US
Practice Address - Phone:915-545-6550
Practice Address - Fax:915-545-6984
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014152367500000X
VA0024178638367500000X
TX715008367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178511501Medicaid
TX85416UOtherBCBS
FL455050056Medicaid