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Deep C Desai

Internal Medicine

Allopathic & Osteopathic Physicians

1250 16th St # C2304, Santa Monica, CA 90404-1249

PECOS Enrollment

This provider is enrolled in PECOS as DEEP DESAI.

Based on the most recent information from CMS, provider Deep C Desai is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1457739732
Provider Type
Individual
Full Name
Desai, Deep C
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/7/2015
Last Updated
6/7/2019

Contact Information

Practice Location

1250 16th St # C2304, Santa Monica, CA 90404-1249

(310) 319-4698

Unlisted Fax

Mailing Location

5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631

(310) 301-8707

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License A157450 California
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License A157450 California

Deep C Desai

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Tu, Joey

Yi, Pauline

Carias, Edson Enrique

Lee, Julia

Boctor, Noelle

Solorzano, Walter Mauricio

Kang, Jeanney

Kaplan, Alexander Brandan

Ahmed, Rafi Syed

Agrawal, Nupur