Provider Demographics
NPI:1790874337
Name:DESAI, RAMESH P (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:P
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17660 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6410
Mailing Address - Country:US
Mailing Address - Phone:562-461-1179
Mailing Address - Fax:562-804-0865
Practice Address - Street 1:17660 LAKEWOOD BOULEVARD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6410
Practice Address - Country:US
Practice Address - Phone:562-461-1179
Practice Address - Fax:562-804-0862
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A319230Medicaid
WA31923Medicare ID - Type Unspecified
CA00A319230Medicaid