Healthcare Provider Details

I. General information

NPI: 1982179065
Provider Name (Legal Business Name): ROXBURY DERMATOLOGY AND MULTISPECIALTY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR STE 410
BEVERLY HILLS CA
90210-4231
US

IV. Provider business mailing address

450 N ROXBURY DR STE 410
BEVERLY HILLS CA
90210-4231
US

V. Phone/Fax

Practice location:
  • Phone: 884-544-1617
  • Fax: 424-394-1627
Mailing address:
  • Phone: 884-544-1617
  • Fax: 424-394-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID M AMRON
Title or Position: PRESIDENT
Credential: M. D.
Phone: 844-544-1617