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General NPI Number Information
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NPI Number | 1588911549
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Entity Type | Organization
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Legal Business Name | ALAMITOS DERMATOLOGICAL MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 17822 BEACH BLVD SUITE 427
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7101
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Country | US
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Telephone | 714-842-7796
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Fax | 714-842-9206
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Provider Business Mailing Address
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Address Line | 3801 KATELLA AVE SUITE 101
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3338
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Country | US
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Telephone | 562-598-8593
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Fax | 562-594-0877
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | DR. MATTHEW BART LUXENBERG
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Credential | M.D.
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Telephone | 562-598-8593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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