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General NPI Number Information
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NPI Number | 1275768004
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Entity Type | Organization
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Legal Business Name | SKIN CANCER&RECONSTRUCTIVE SX SPECIALISTS OF VALENCIA
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 9001 WILSHIRE BLVD 106
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1838
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Country | US
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Telephone | 310-273-8849
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Fax | 866-664-7321
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Provider Business Mailing Address
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Address Line | 9001 WILSHIRE BLVD 106
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1849
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Country | US
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Telephone | 310-273-8849
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Fax | 866-664-7321
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL OMIDI
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Credential | MD
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Telephone | 310-273-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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