Individual provider Active NPI

Gardy F Desroches, RN

  • Registered Nurse
  • San Mateo, CA
National Provider Identifier
1093408130
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
95422644 Issued in CA
Practice address
1700 S Amphlett Blvd
San Mateo, CA 94402-2701
Phone
(239) 304-6187
NPI assigned
Jun 2, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95422644 CA Primary

Addresses

Primary practice location

1700 S Amphlett Blvd
San Mateo, CA 94402-2701

Mailing address

1700 S Amphlett Blvd
San Mateo, CA 94402-2701
Phone (239) 304-6187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
95422644CAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1093408130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S AMPHLETT BLVD",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022701",
            "telephone_number": "239-304-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S AMPHLETT BLVD",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022701",
            "telephone_number": "239-304-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESROCHES",
        "first_name": "GARDY",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-02",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95422644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.