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General NPI Number Information
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NPI Number | 1194518977
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Entity Type | Organization
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Legal Business Name | DEHESA DERMATOLOGY INC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 978 N TEMPERANCE AVE
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City | CLOVIS
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State | CA
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Zip | 93611-8606
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Country | US
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Telephone | 617-314-3845
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Fax |
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Provider Business Mailing Address
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Address Line | 1565 E FOREST OAKS DR
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City | FRESNO
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State | CA
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Zip | 93730-3445
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Country | US
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Telephone | 786-320-0555
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LUIS A DEHESA
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Credential | MD
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Telephone | 786-320-0555
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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 | 207RR0500X
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Taxonomy Name | Rheumatology 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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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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