Provider Demographics
NPI:1396141230
Name:DESAI, ARCHIS D (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHIS
Middle Name:D
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 NEVADA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2957
Mailing Address - Country:US
Mailing Address - Phone:909-966-5500
Mailing Address - Fax:909-966-5222
Practice Address - Street 1:1030 NEVADA ST STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2957
Practice Address - Country:US
Practice Address - Phone:909-966-5500
Practice Address - Fax:909-966-5222
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144563207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine