| Desante Med Group | |
|
7136 Haskell Ave Ste 210 Van Nuys CA 91406-4112 | |
| (818) 900-0009 | |
| Not Available |
| Full Name | Desante Med Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 7136 Haskell Ave Ste 210, Van Nuys, California |
| Authorized Official Name and Position | Tehmine Tina Nagdalian (CEO) |
| Authorized Official Contact | 8189000009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desante Med Group 7136 Haskell Ave Ste 210 Van Nuys CA 91406-4112 | Desante Med Group 7136 Haskell Ave Ste 210 Van Nuys CA 91406-4112 Ph: (818) 900-0009 |
| NPI Number | 1689562100 |
|---|---|
| Provider Enumeration Date | 06/24/2025 |
| Last Update Date | 06/24/2025 |
| Certification Date | 06/24/2025 |
| Medicare PECOS PAC ID | 2264933159 |
|---|---|
| Medicare Enrollment ID | O20250902001225 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689562100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Philip H Lee |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992981161 PECOS PAC ID: 7113086760 Enrollment ID: I20081111000564 |
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