Healthcare Provider Details

I. General information

NPI: 1881023927
Provider Name (Legal Business Name): ADVANCED DERMATOLOGY & SKIN CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31720 TEMECULA PKWY SUITE #203
TEMECULA CA
92592-5802
US

IV. Provider business mailing address

31720 TEMECULA PKWY SUITE #203
TEMECULA CA
92592-5802
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6900
  • Fax: 951-303-2900
Mailing address:
  • Phone: 951-303-6900
  • Fax: 951-303-2900

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 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: DR. JESSE DAVID MITCHELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-303-6900