Provider Demographics
NPI:1881280519
Name:DESENA, MICHAEL V
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:DESENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25109 JEFFERSON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8117
Mailing Address - Country:US
Mailing Address - Phone:951-297-7773
Mailing Address - Fax:
Practice Address - Street 1:24116 TUSCANY AVE UNIT 1901
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1297
Practice Address - Country:US
Practice Address - Phone:360-720-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA937191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical