Healthcare Provider Details

I. General information

NPI: 1881577781
Provider Name (Legal Business Name): DERMACRAFT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N CENTRAL AVE STE A
GLENDALE CA
91203-3526
US

IV. Provider business mailing address

237 N CENTRAL AVE STE A
GLENDALE CA
91203-3526
US

V. Phone/Fax

Practice location:
  • Phone: 818-807-0530
  • Fax:
Mailing address:
  • Phone: 818-807-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: KHRIS KAKOSIMIDI
Title or Position: CFO
Credential:
Phone: 818-807-0530