Healthcare Provider Details

I. General information

NPI: 1114979754
Provider Name (Legal Business Name): ERIC S. GERSTENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 INNOVATION DR.
SAN DIEGO CA
92128-3409
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD. 2ND FL.
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-605-7808
  • Fax: 858-605-7333
Mailing address:
  • Phone: 858-605-7808
  • Fax: 858-605-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG70325
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG70325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: