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General NPI Number Information
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NPI Number | 1568527893
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Entity Type | Organization
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Legal Business Name | ADVANCED AESTHETIC DERMATOLOGY
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 14651 SO BASCOM AVE 200
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-358-5757
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Fax | 408-358-8951
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Provider Business Mailing Address
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Address Line | 14651 SO BASCOM AVE 200
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-358-5757
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Fax | 408-358-8951
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. PATRICK HENRY BITTER JR.
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Credential | MD
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Telephone | 408-358-5757
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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 | G50914
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License Number State | CA
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