Healthcare Provider Details

I. General information

NPI: 1568561256
Provider Name (Legal Business Name): CITY OF ANGELS DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PACIFIC COAST HWY STE 220
TORRANCE CA
90505-6660
US

IV. Provider business mailing address

13157 MINDANAO WAY STE 33
MARINA DEL REY CA
90292-6307
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-8240
  • Fax: 310-651-8254
Mailing address:
  • Phone: 310-651-8240
  • Fax: 310-651-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: MARTIN BILLIPS
Title or Position: CEO
Credential:
Phone: 310-651-8240