Provider Demographics
NPI:1194776740
Name:DESOUZA, LUIS RAFAEL (MD, PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:DESOUZA
Suffix:
Gender:M
Credentials:MD, PHD, MPH
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:R
Other - Last Name:DESOUZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD, MPH
Mailing Address - Street 1:2001 ZINFANDEL DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-859-9934
Mailing Address - Fax:916-859-9994
Practice Address - Street 1:2001 ZINFANDEL DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-859-9934
Practice Address - Fax:916-859-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA412382083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A8852Medicare UPIN