Healthcare Provider Details

I. General information

NPI: 1760663116
Provider Name (Legal Business Name): MIREMADI DERMATOLOGY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 IVANHOE AVE
LA JOLLA CA
92037-4520
US

IV. Provider business mailing address

7702 IVANHOE AVE
LA JOLLA CA
92037-4520
US

V. Phone/Fax

Practice location:
  • Phone: 858-456-1840
  • Fax:
Mailing address:
  • Phone: 858-456-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberA31016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA31016
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA31016
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA31016
License Number StateCA

VIII. Authorized Official

Name: DR. ARJANG K MIREMADI
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 858-456-1840