Healthcare Provider Details

I. General information

NPI: 1164100848
Provider Name (Legal Business Name): CALIFORNIA DERMATOLOGY INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W PALMDALE BLVD STE A
PALMDALE CA
93551-4230
US

IV. Provider business mailing address

520 W PALMDALE BLVD STE A
PALMDALE CA
93551-4230
US

V. Phone/Fax

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

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: OWNER
Credential:
Phone: 805-222-5803