Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | 343419 | OH |
NPI | 1124580204 |
---|---|
Provider Name | Mrs. Jessica Desalvo |
First Address | Columbus, OH 43228-1607 |
Second Address | Columbus, OH 43228-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 20/11/2019 |