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General NPI Number Information
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NPI Number | 1912026097
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY & COSMETICS LASER CARE A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 28212 KELLY JOHNSON PKWY SUITE 245
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City | VALENCIA
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State | CA
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Zip | 91355-5084
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Country | US
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Telephone | 661-254-3686
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Fax | 661-254-5671
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Provider Business Mailing Address
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Address Line | 28212 KELLY JOHNSON PKWY SUITE 245
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City | VALENCIA
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State | CA
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Zip | 91355-5084
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Country | US
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Telephone | 661-254-3686
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Fax | 661-254-5671
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BERNARD I RASKIN
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Credential | MD
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Telephone | 661-254-3686
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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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