Provider Demographics
NPI:1912023904
Name:DE SESA, ROGER MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:MICHAEL
Last Name:DE SESA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27674 NEWHALL RANCH RD
Mailing Address - Street 2:SUITE #65
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4018
Mailing Address - Country:US
Mailing Address - Phone:661-294-0429
Mailing Address - Fax:661-294-0439
Practice Address - Street 1:27674 NEWHALL RANCH RD
Practice Address - Street 2:SUITE #65
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4018
Practice Address - Country:US
Practice Address - Phone:661-294-0429
Practice Address - Fax:661-294-0439
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor