Provider Demographics
NPI:1144247990
Name:DESA, MARGARET MARY (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:DESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1900
Mailing Address - Country:US
Mailing Address - Phone:714-778-0623
Mailing Address - Fax:714-778-3437
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:SUITE N-351
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-480-0044
Practice Address - Fax:714-480-0060
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist