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General NPI Number Information
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NPI Number | 1578763876
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY SPECIALISTS INC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 838 NORDAHL RD #250
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City | SAN MARCOS
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State | CA
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Zip | 92069-3595
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Country | US
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Telephone | 760-738-7600
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Fax | 760-738-7616
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Provider Business Mailing Address
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Address Line | 3629 VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-4522
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Country | US
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Telephone | 760-828-9200
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Fax | 760-828-9141
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANE LISK
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Credential |
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Telephone | 760-757-7546
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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 | CA
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