Healthcare Provider Details

I. General information

NPI: 1275341414
Provider Name (Legal Business Name): PASADENA PREMIER DERMATOLOGY PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 330
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST STE 330
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4207
  • Fax: 626-449-0925
Mailing address:
  • Phone: 626-449-4207
  • Fax: 626-449-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DAVID A DENENHOLZ
Title or Position: PARTNER
Credential: MD
Phone: 626-449-4207