Healthcare Provider Details

I. General information

NPI: 1427170984
Provider Name (Legal Business Name): VALLEY DERMATOLOGY AND SKIN CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 140
ENCINO CA
91436-5103
US

IV. Provider business mailing address

16260 VENTURA BLVD STE 140
ENCINO CA
91436-5103
US

V. Phone/Fax

Practice location:
  • Phone: 818-528-2500
  • Fax: 818-528-2505
Mailing address:
  • Phone: 818-528-2500
  • Fax: 818-528-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA88950
License Number StateCA

VIII. Authorized Official

Name: DR. MEHDI FARSHAD DERAMBAKHSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-528-2500