MEDICARE: CALIFORNIA DERMATOLOGY INSTITUTE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1033051925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA DERMATOLOGY INSTITUTE PC

Provider Business Mailing Address
First Line	:	3095 OLD CONEJO RD STE 200
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 W MAIN ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2920
Country	:	US
Telephone Number	:	805-222-5803
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAVID EZRA
Credential	:
Telephone Number	:	805-222-5803

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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