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General NPI Number Information
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NPI Number | 1710385901
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Entity Type | Organization
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Legal Business Name | CITY OF ANGELS DERMATOLOGY INC
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Dates
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Enumeration Date | 12/20/2014
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Last Update Date | 12/20/2014
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Provider Practice Location Address
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Address Line | 2888 LONG BEACH BLVD STE 325
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City | LONG BEACH
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State | CA
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Zip | 90806-7503
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Country | US
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Telephone | 562-366-0300
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Fax | 562-366-7525
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Provider Business Mailing Address
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Address Line | 4712 ADMIRALTY WAY # 665
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 562-366-0300
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Fax | 562-366-7525
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MAVIS BILLIPS
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Credential | MD
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Telephone | 310-651-8240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLM 000346987
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License Number State | CA
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