Healthcare Provider Details

I. General information

NPI: 1750691010
Provider Name (Legal Business Name): BOUGHTON DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE SUITE 202
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7300 GIRARD AVE SUITE 202
LA JOLLA CA
92037-5138
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-7123
  • Fax: 858-454-5724
Mailing address:
  • Phone: 858-454-7123
  • Fax: 858-454-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOANELLA CALAME
Title or Position: DERMATOLOGIST
Credential: M.D.
Phone: 858-353-5159