MEDICARE: CALIFORNIA DERMATOLOGY INSTITUTE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1578419131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA DERMATOLOGY INSTITUTE PC

Provider Business Mailing Address
First Line	:	3095 OLD CONEJO RD STE 200
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 BROCKTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4004
Country	:	US
Telephone Number	:	805-298-7034
Fax Number	:	805-298-7139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAVID EZRA
Credential	:
Telephone Number	:	805-298-7034

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/12/2026

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