Blaise Desouza Md | |
23000 Foresthill Rd Foresthill CA 95631 | |
(530) 367-2229 | |
(530) 367-4161 |
Full Name | Blaise Desouza Md |
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Speciality | General Practice |
Location | 23000 Foresthill Rd, Foresthill, California |
Authorized Official Name and Position | Blaise Philip Desouza (PRESIDENT) |
Authorized Official Contact | 5303672229 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Blaise Desouza Md Po Box 1040 Foresthill CA 95631-1040 Ph: (530) 367-2229 | Blaise Desouza Md 23000 Foresthill Rd Foresthill CA 95631 Ph: (530) 367-2229 |
NPI Number | 1568410421 |
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Provider Enumeration Date | 05/04/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568410421 | NPI | - | NPPES |
5362017 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | A37917 (California) | Primary |