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General NPI Number Information
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NPI Number | 1043536543
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY CARE, INC.
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 2262 CAMINO RAMON
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-328-0255
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Fax | 925-328-0257
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Provider Business Mailing Address
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Address Line | 2262 CAMINO RAMON
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-328-0255
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Fax | 925-328-0257
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FLORA TING
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Credential |
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Telephone | 925-328-0255
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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 | A82266
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | A82266
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License Number State | CA
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