Individual
DR. AMRITA MANGLESH DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 FLORIDA AVE STE 102, MODESTO, CA 95350-4446
(209) 573-6147
Mailing address
1400 FLORIDA AVE STE 102, MODESTO, CA 95350-4446
(209) 573-6147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12499
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12499
PTL
CA
Enumeration date
04/07/2023
Last updated
02/19/2024
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