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General NPI Number Information
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NPI Number | 1235516915
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Entity Type | Organization
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Legal Business Name | DERM CONTACT PLLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 31515 RANCHO PUEBLO RD SUITE 105
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City | TEMECULA
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State | CA
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Zip | 92592
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Country | US
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Telephone | 951-834-5303
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Fax | 951-943-4645
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Provider Business Mailing Address
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Address Line | 31515 RANCHO PUEBLO RD SUITE 105
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City | TEMECULA
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State | CA
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Zip | 92592
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Country | US
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Telephone | 951-834-5303
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Fax | 951-943-4645
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Authorized Official
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Title or Position | OWNER
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Name | MR. QUINN CHRISTENSEN
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Credential |
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Telephone | 951-834-5303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 55273
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License Number State | CA
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