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General NPI Number Information
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NPI Number | 1457656225
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Entity Type | Organization
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Legal Business Name | PEACHWOOD AESTHETIC SKINCARE CENTER INC.
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 275 W HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93612-0204
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Country | US
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Telephone | 559-324-8700
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Fax | 559-324-8777
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Provider Business Mailing Address
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Address Line | 275 W HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93612-0204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER YAO
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Credential | M.D.
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Telephone | 559-324-8700
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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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