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General NPI Number Information
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NPI Number | 1477880136
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Entity Type | Organization
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Legal Business Name | THE DERMATOLOGY CENTER OF NORTHERN CALIFORNIA, INC.
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 192 BLUE RAVINE ROAD SUITE 100
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City | FOLSOM
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State | CA
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Zip | 95630
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Country | US
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Telephone | 916-983-3373
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Fax | 916-983-7037
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Provider Business Mailing Address
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Address Line | 192 BLUE RAVINE ROAD SUITE 100
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City | FOLSOM
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State | CA
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Zip | 95630
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Country | US
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Telephone | 916-983-3373
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Fax | 916-983-7037
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | DAVID NO
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Credential | M.D., PHD
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Telephone | 916-983-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A78404
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | A78404
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A78404
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License Number State | CA
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