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General NPI Number Information
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NPI Number | 1154609584
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Entity Type | Organization
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Legal Business Name | AMERICAN DERMATOLOGY CENTERS
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 416 N BEDFORD DR SUITE 306
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4322
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Country | US
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Telephone | 310-360-6661
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Fax | 310-360-6669
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Provider Business Mailing Address
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Address Line | PO BOX 15717
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-1717
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Country | US
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Telephone | 310-360-6661
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Fax | 310-360-6669
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. GLENN NEIL LEDESMA
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Credential | M.D
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Telephone | 310-360-6661
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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 | G44761
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License Number State | CA
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