Provider Demographics
NPI:1942233671
Name:D'SA, PEARL P (MD)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:P
Last Name:D'SA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 JUANITA ST APT 99
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4077
Mailing Address - Country:US
Mailing Address - Phone:714-761-1142
Mailing Address - Fax:
Practice Address - Street 1:407 W IMPERIAL HWY # H-171
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4832
Practice Address - Country:US
Practice Address - Phone:562-365-3540
Practice Address - Fax:562-365-3532
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07975100207R00000X
CAA93532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI49885Medicare UPIN