Healthcare Provider Details

I. General information

NPI: 1437903481
Provider Name (Legal Business Name): DERMATOLOGY INSTITUTE FOR SKIN CANCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CHESTER AVENUE SUITE 103
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

1301 SAN REMO DRIVE
PACIFIC PALISADES CA
90272
US

V. Phone/Fax

Practice location:
  • Phone: 661-837-7084
  • Fax: 661-837-7186
Mailing address:
  • Phone: 201-852-5980
  • Fax: 661-837-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEOVER FERNANDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 661-803-2428