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General NPI Number Information
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NPI Number | 1538743752
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Entity Type | Organization
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Legal Business Name | DERMESURGE INC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 09/10/2023
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE STE K
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 909-860-4254
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE STE K
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 190-986-0425
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAM ABAZA
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Credential | MD
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Telephone | 818-726-8722
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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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