Healthcare Provider Details

I. General information

NPI: 1720723448
Provider Name (Legal Business Name): DERMATOLOGY COLLECTIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 W FOOTHILL BLVD STE 202
GLENDORA CA
91741-2470
US

IV. Provider business mailing address

552 W FOOTHILL BLVD STE 202
GLENDORA CA
91741-2470
US

V. Phone/Fax

Practice location:
  • Phone: 818-795-8252
  • Fax:
Mailing address:
  • Phone: 626-240-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TOMASSIAN
Title or Position: OWNER
Credential:
Phone: 626-240-2020