Basic Information
| Provider Information | |||||||||
| NPI: | 1326202748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHUPAT H DESAI MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 N 13TH AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099822719 | ||||||||
| FaxNumber: | 9099469931 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 N 13TH AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099822719 | ||||||||
| FaxNumber: | 9099469931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 01/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | DESAI | ||||||||
| AuthorizedOfficialFirstName: | BHUPAT | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099822719 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A33896 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1326202748 | 05 | CA | MEDICAID |