=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548489602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH PACIFIC DERMATOLOGY A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3103 CONCORDE DR
-----------------------------------------------------
City | MCKINLEYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95519-9305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-822-3376
-----------------------------------------------------
Fax | 707-822-5053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 S RAILROAD AVE
-----------------------------------------------------
City | CRESCENT CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95531-6821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-464-8335
-----------------------------------------------------
Fax | 707-464-8339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUSTIN ARNOLD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 707-822-3376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | G77600
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------