Provider Demographics
NPI:1770746356
Name:DESAI, ANJALI PINAK (AP, LAC)
Entity type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:PINAK
Last Name:DESAI
Suffix:
Gender:F
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 VIA BLAIRO
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8825
Mailing Address - Country:US
Mailing Address - Phone:909-614-3936
Mailing Address - Fax:
Practice Address - Street 1:1115 VIA BLAIRO
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-8825
Practice Address - Country:US
Practice Address - Phone:909-614-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2559171100000X
CAAC15039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist