Basic Information
| Provider Information | |||||||||
| NPI: | 1023210473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARROGA | ||||||||
| FirstName: | DESI | ||||||||
| MiddleName: | ELPIDIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-1666 AUWAHA ST | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967061814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182205589 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1420 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185021900 | ||||||||
| FaxNumber: | 8182464104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | A97526 | CA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085R0202X | A97256 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.