Healthcare Provider Details

I. General information

NPI: 1073710059
Provider Name (Legal Business Name): SAVES THE DAY DERMATOLOGY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 E 17TH ST STE 101
COSTA MESA CA
92627-3763
US

IV. Provider business mailing address

3553 CAMINO MIRA COSTA STE H
SAN CLEMENTE CA
92672-3512
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7110
  • Fax:
Mailing address:
  • Phone: 949-542-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG93542
License Number StateCA

VIII. Authorized Official

Name: ATHENA PARAS
Title or Position: BILLING MANAGER
Credential:
Phone: 949-542-3040