Basic Information
| Provider Information | |||||||||
| NPI: | 1649362633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | BHUPAT | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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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: | 09/28/2006 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A33896 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1326202748 | 05 | CA | MEDICAID |