Healthcare Provider Details

I. General information

NPI: 1366124539
Provider Name (Legal Business Name): MAVEN DERMATOLOGY APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CONVOY ST STE 155
SAN DIEGO CA
92111-3739
US

IV. Provider business mailing address

3750 CONVOY ST STE 155
SAN DIEGO CA
92111-3739
US

V. Phone/Fax

Practice location:
  • Phone: 858-736-9900
  • Fax: 858-736-0661
Mailing address:
  • Phone: 858-736-9900
  • Fax: 858-736-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSLEEN AHLUWALIA
Title or Position: CEO
Credential: MD
Phone: 858-736-9900