Healthcare Provider Details

I. General information

NPI: 1194518977
Provider Name (Legal Business Name): DEHESA DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 N TEMPERANCE AVE
CLOVIS CA
93611-8606
US

IV. Provider business mailing address

1565 E FOREST OAKS DR
FRESNO CA
93730-3445
US

V. Phone/Fax

Practice location:
  • Phone: 617-314-3845
  • Fax:
Mailing address:
  • Phone: 786-320-0555
  • Fax:

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 Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS A DEHESA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 786-320-0555