Healthcare Provider Details

I. General information

NPI: 1063502227
Provider Name (Legal Business Name): CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42600 MIRAGE RD
RANCHO MIRAGE CA
92270-4127
US

IV. Provider business mailing address

42600 MIRAGE RD STE A1
RANCHO MIRAGE CA
92270-4127
US

V. Phone/Fax

Practice location:
  • Phone: 760-423-4000
  • Fax: 760-318-8103
Mailing address:
  • Phone: 760-423-4000
  • Fax: 760-318-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA70216
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE ELIAS ERWIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-423-4043