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General NPI Number Information
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NPI Number | 1023311172
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Entity Type | Organization
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Legal Business Name | COASTAL VALLEY DERMATOLOGY ASSOCIATES, INC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 757 PACIFIC ST STE C3
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City | MONTEREY
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State | CA
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Zip | 93940-2819
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Country | US
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Telephone | 831-293-8458
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Fax |
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Provider Business Mailing Address
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Address Line | 757 PACIFIC ST STE C3
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City | MONTEREY
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State | CA
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Zip | 93940-2819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROYA JAVID
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Credential | MD
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Telephone | 619-895-2940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A77492
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License Number State | CA
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