1447209382 NPI number — DESAC GROUP INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447209382 NPI number — DESAC GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESAC GROUP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447209382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28041 HAWTHORNE BLVD
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
RANCHO PALOS VERDES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90275-3271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28041 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
RANCHO PALOS VERDES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90275-3271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-265-4935
Provider Business Practice Location Address Fax Number:
310-541-1913
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AKALONU
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
EMECHETA
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
310-265-4935

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  43367 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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