Provider Demographics
NPI:1770733446
Name:DE SOUZA, AIESKA (MD, MSC)
Entity type:Individual
Prefix:DR
First Name:AIESKA
Middle Name:
Last Name:DE SOUZA
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8220 WYMARK DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6297
Practice Address - Country:US
Practice Address - Phone:916-667-0600
Practice Address - Fax:916-683-0232
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250593207N00000X
CAA137775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology