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General NPI Number Information
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NPI Number | 1235671389
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DERMATOLOGY INSTITUTE PC
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 3095 OLD CONEJO RD STE 200
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2130
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Country | US
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Telephone | 805-222-5803
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Fax |
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Provider Business Mailing Address
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Address Line | 3095 OLD CONEJO RD, SUITE 200
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2130
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Country | US
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Telephone | 805-222-5803
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Fax | 805-222-0323
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Authorized Official
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Title or Position | MD
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Name | NAVID EZRA
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Credential | MD
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Telephone | 805-222-5803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 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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