Healthcare Provider Details

I. General information

NPI: 1669612362
Provider Name (Legal Business Name): AMERICAN SKIN AND CANCER CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 N FRESNO ST SUITE 310
FRESNO CA
93720-2957
US

IV. Provider business mailing address

7055 N FRESNO ST SUITE 310
FRESNO CA
93720-2957
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-1070
  • Fax: 559-446-1646
Mailing address:
  • Phone: 559-446-1070
  • Fax: 559-446-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology 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
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA07004000
License Number StateNJ

VIII. Authorized Official

Name: MS. ZULEICA MURILLO
Title or Position: DEVELOPMENT
Credential:
Phone: 559-446-1070