Healthcare Provider Details

I. General information

NPI: 1174183925
Provider Name (Legal Business Name): DERMATOLOGY AND FACIAL PLASTICS EXPERTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N. RODEO DR T7
BEVERLY HILLS CA
90210-4500
US

IV. Provider business mailing address

421 N. RODEO DR T7
BEVERLY HILLS CA
90210-4500
US

V. Phone/Fax

Practice location:
  • Phone: 910-274-5372
  • Fax: 310-274-5380
Mailing address:
  • Phone: 910-274-5372
  • Fax: 310-274-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD L MOY
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 310-274-5327