1326202748 NPI number — BHUPAT H DESAI MD INC

Table of content: (NPI 1326202748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326202748 NPI number — BHUPAT H DESAI MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHUPAT H DESAI MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326202748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 N 13TH AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-982-2719
Provider Business Mailing Address Fax Number:
909-946-9931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 N 13TH AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-982-2719
Provider Business Practice Location Address Fax Number:
909-946-9931
Provider Enumeration Date:
07/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
BHUPAT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-982-2719

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A33896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1326202748 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com