| Doctor Name: | BLAISE DESOUZA |
| NPI Number: | 1144433343 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD INC |
| License Number: | A37917 |
| Business Practice Address: | 23000 Foresthill Rd Foresthill, CA - 956311040 |
| Business Phone Number: | 5303672229 |
| Business Fax Number: | 5303674161 |
| Mailing Address: | Po Box 1040, FORESTHILL |
| State: | CA |
| Postal Code: | 956311040 |
| Phone Number: | 5303672229 |
| Fax Number: | 5303674161 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A37917 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |