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General NPI Number Information
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NPI Number | 1366903825
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Entity Type | Organization
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Legal Business Name | DERMA NOOR, INC.
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 14331 EUCLID ST STE 104
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City | GARDEN GROVE
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State | CA
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Zip | 92843-6509
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Country | US
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Telephone | 714-852-3311
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Fax | 714-852-3995
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Provider Business Mailing Address
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Address Line | 14331 EUCLID ST STE 104
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City | GARDEN GROVE
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State | CA
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Zip | 92843-6509
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Country | US
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Telephone | 714-852-3311
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Fax | 714-852-3995
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAZA MEHDI
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Credential | MD
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Telephone | 714-852-3311
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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