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General NPI Number Information
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NPI Number | 1568523793
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Entity Type | Organization
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Legal Business Name | WEST DERMATOLOGY OF NORTHERN CALIFORNIA, INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 1444 FLORIDA AVE SUITE 201
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City | MODESTO
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State | CA
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Zip | 95350-4400
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Country | US
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Telephone | 209-526-4384
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Fax | 209-526-4385
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Provider Business Mailing Address
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Address Line | 101 E REDLANDS BLVD SUITE 212
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City | REDLANDS
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State | CA
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Zip | 92373-4775
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Country | US
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Telephone | 909-335-8649
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Fax | 909-335-1994
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J ROBERT WEST SR.
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Credential | M.D.
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Telephone | 909-335-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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