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General NPI Number Information
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NPI Number | 1124328505
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Entity Type | Organization
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Legal Business Name | CARLSBAD AND VISTA DERMATOLOGY, INC.
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 2395 S MELROSE DR
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City | VISTA
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State | CA
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Zip | 92081-8788
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Country | US
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Telephone | 760-402-9715
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Fax |
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Provider Business Mailing Address
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Address Line | 2395 S MELROSE DR
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City | VISTA
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State | CA
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Zip | 92081-8788
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Country | US
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Telephone | 760-402-9715
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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. VU NGUYEN
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Credential | M.D.
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Telephone | 760-402-9715
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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 | A97816
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License Number State | CA
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