Healthcare Provider Details

I. General information

NPI: 1891516266
Provider Name (Legal Business Name): PRIME DERMATOLOGY AND SKIN CANCER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30131 TOWN CENTER DR STE 280
LAGUNA NIGUEL CA
92677-2086
US

IV. Provider business mailing address

30131 TOWN CENTER DR STE 280
LAGUNA NIGUEL CA
92677-2086
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-9737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MINA ZAREI
Title or Position: FOUNDER
Credential: MD
Phone: 786-369-9146