Provider Demographics
NPI:1245673896
Name:DESA, NOLAN STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:STEPHEN
Last Name:DESA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1045 ATLANTIC AVE STE 1004
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3423
Mailing Address - Country:US
Mailing Address - Phone:562-432-9911
Mailing Address - Fax:562-391-0180
Practice Address - Street 1:1760 TERMINO AVE STE G18
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2169
Practice Address - Country:US
Practice Address - Phone:562-494-6700
Practice Address - Fax:562-391-0180
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2022-06-28
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Provider Licenses
StateLicense IDTaxonomies
CAA160199207RB0002X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine