Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E2474 | CA |
NPI | 1053317545 |
---|---|
Provider Name | Dr. Nicholas Nelson Desantis |
First Address | San Diego, CA 92101-1643 |
Second Address | San Diego, CA 92101-1643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 07/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E24740 | BLUE CROSS (01) | CA |
000E24741 | (05) | CA |
T19202 | (02) | CA |