Healthcare Provider Details

I. General information

NPI: 1548773286
Provider Name (Legal Business Name): ZAND DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD STE 246
MILL VALLEY CA
94941-3055
US

IV. Provider business mailing address

655 REDWOOD HWY FRONTAGE RD STE 246
MILL VALLEY CA
94941-3055
US

V. Phone/Fax

Practice location:
  • Phone: 415-301-5000
  • Fax: 844-719-5148
Mailing address:
  • Phone: 415-301-5000
  • Fax: 844-719-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA97783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUCRETIA ANN LEWITT
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-925-0550