Provider Demographics
NPI:1255362802
Name:DESAI, VASUDEVA (MD)
Entity type:Individual
Prefix:
First Name:VASUDEVA
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ZINFANDEL DR
Mailing Address - Street 2:A-1
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4265
Mailing Address - Country:US
Mailing Address - Phone:916-859-9934
Mailing Address - Fax:916-859-9994
Practice Address - Street 1:2001 ZINFANDEL DR
Practice Address - Street 2:A-1
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4265
Practice Address - Country:US
Practice Address - Phone:916-859-9934
Practice Address - Fax:916-859-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25787Medicare UPIN