Healthcare Provider Details

I. General information

NPI: 1366511008
Provider Name (Legal Business Name): SKIN CANCER AND RECONSTRUCTIVE SURGERY SPECIALISTS OF BEVERLY HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 E PALMDALE BLVD STE 207
PALMDALE CA
93550-2034
US

IV. Provider business mailing address

1171 S ROBERTSON BLVD STE 229
LOS ANGELES CA
90035-1403
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 TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEAL M AMMAR
Title or Position: OPERATOR
Credential: M.D.
Phone: 310-273-8885