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General NPI Number Information
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NPI Number | 1881316701
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DERMATOLOGY AND MOHS SURGERY SPECIALISTS INC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 50 BELLEFONTAINE ST STE 202
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City | PASADENA
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State | CA
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Zip | 91105-3132
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Country | US
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Telephone | 818-636-9039
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BELLEFONTAINE ST STE 202
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City | PASADENA
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State | CA
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Zip | 91105-3132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED CREDENTIALING SPECIALIST
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Name | MARIAH GINN
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Credential |
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Telephone | 805-392-5138
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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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