Provider Demographics
NPI:1669568580
Name:JEFFREY R DESANTIS DPM PC
Entity type:Organization
Organization Name:JEFFREY R DESANTIS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-771-4191
Mailing Address - Street 1:1038 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2111
Mailing Address - Country:US
Mailing Address - Phone:714-771-4191
Mailing Address - Fax:714-771-2731
Practice Address - Street 1:1038 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2111
Practice Address - Country:US
Practice Address - Phone:714-771-4191
Practice Address - Fax:714-771-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0791680001OtherDMERC