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General NPI Number Information
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NPI Number | 1043090582
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Entity Type | Organization
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Legal Business Name | OASIS DERMATOLOGY, INC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 02/04/2024
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Provider Practice Location Address
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Address Line | 12565 HESPERIA RD STE 3
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City | VICTORVILLE
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State | CA
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Zip | 92395-8318
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Country | US
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Telephone | 760-780-0003
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Fax | 760-766-1908
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Provider Business Mailing Address
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Address Line | 12565 HESPERIA RD STE 3
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City | VICTORVILLE
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State | CA
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Zip | 92395-8318
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Country | US
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Telephone | 760-780-0003
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Fax | 760-766-1908
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIZA GILL
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Credential | MD
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Telephone | 760-780-0003
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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 |
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License Number State |
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