Healthcare Provider Details

I. General information

NPI: 1316621493
Provider Name (Legal Business Name): ELK GROVE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 G ST STE E
MERCED CA
95340-1346
US

IV. Provider business mailing address

3150 G ST STE E
MERCED CA
95340-1346
US

V. Phone/Fax

Practice location:
  • Phone: 510-789-3094
  • Fax:
Mailing address:
  • Phone: 510-789-3094
  • 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: JASPREET SINGH NANRA
Title or Position: OWNER
Credential: MD
Phone: 510-789-3094