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General NPI Number Information
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NPI Number | 1275341414
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Entity Type | Organization
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Legal Business Name | PASADENA PREMIER DERMATOLOGY PARTNERS
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 960 E GREEN ST STE 330
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City | PASADENA
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State | CA
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Zip | 91106-2401
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Country | US
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Telephone | 626-449-4207
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Fax | 626-449-0925
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Provider Business Mailing Address
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Address Line | 960 E GREEN ST STE 330
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City | PASADENA
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State | CA
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Zip | 91106-2401
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Country | US
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Telephone | 626-449-4207
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Fax | 626-449-0925
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Authorized Official
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Title or Position | PARTNER
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Name | DAVID A DENENHOLZ
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Credential | MD
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Telephone | 626-449-4207
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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