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General NPI Number Information
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NPI Number | 1871697136
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Entity Type | Organization
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Legal Business Name | ACCREDITED DERMATOLOGY MEDICAL CLINIC INC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 W BASTANCHURY ROAD SUITE 245
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City | FULLERTON
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State | CA
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Zip | 92835
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Country | US
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Telephone | 714-525-3500
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Fax | 714-525-3588
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Provider Business Mailing Address
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Address Line | PO BOX 5859
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City | FULLERTON
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State | CA
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Zip | 92838
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Country | US
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Telephone | 714-525-3500
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Fax | 714-525-3588
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Authorized Official
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Title or Position | PHYSICIAN
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Name | PATRICK ROBERT DAHL
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Credential | MD
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Telephone | 714-525-3500
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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 |
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