Healthcare Provider Details

I. General information

NPI: 1811776560
Provider Name (Legal Business Name): WILLIAM F RESH MD, SKIN & SKIN CANCER MEDICAL GROUP OF SAN DIEGO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 102
POWAY CA
92064-2057
US

IV. Provider business mailing address

655 EUCLID AVE STE 304
NATIONAL CITY CA
91950-2974
US

V. Phone/Fax

Practice location:
  • Phone: 619-267-8303
  • Fax: 619-267-4835
Mailing address:
  • Phone: 619-267-8303
  • Fax: 619-267-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: YARELI KELLY CIFUENTES
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-267-8303