Healthcare Provider Details

I. General information

NPI: 1245195510
Provider Name (Legal Business Name): CALIFORNIA DERMATOLOGY INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25470 MEDICAL CENTER DR STE 203
MURRIETA CA
92562-4901
US

IV. Provider business mailing address

3095 OLD CONEJO RD STE 200
THOUSAND OAKS CA
91320-2130
US

V. Phone/Fax

Practice location:
  • Phone: 805-298-7034
  • Fax: 805-298-7139
Mailing address:
  • Phone: 805-298-7034
  • Fax: 805-298-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: NAVID EZRA
Title or Position: PRESIDENT
Credential:
Phone: 805-222-5803