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General NPI Number Information
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NPI Number | 1073152112
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Entity Type | Organization
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Legal Business Name | AGAPE DERMATOLOGY PC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 06/13/2020
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Provider Practice Location Address
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Address Line | 18800 MAIN ST STE 111
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1717
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Country | US
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Telephone | 714-961-9119
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Fax | 714-951-9149
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Provider Business Mailing Address
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Address Line | 18800 MAIN ST STE 111
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1717
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Country | US
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Telephone | 714-951-9119
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Fax | 714-951-9149
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Authorized Official
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Title or Position | CEO
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Name | DR. TERESA ZAMARY
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Credential | DO
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Telephone | 714-951-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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