Healthcare Provider Details

I. General information

NPI: 1174681720
Provider Name (Legal Business Name): SKIN CANCER AND RECONSTRUCTIVE SURGERY SPECIALIST OF BEVERLY HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 PALMDALE BLVD STE 207
PALMDALE CA
93550
US

IV. Provider business mailing address

9001 WILSHIRE BLVD #106
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-1900
  • Fax: 661-267-0700
Mailing address:
  • Phone: 310-273-8885
  • Fax: 310-273-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA92792
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA92792
License Number StateCA

VIII. Authorized Official

Name: NEAL AMMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 661-267-1900