MEDICARE: HENDERSON DERMATOLOGY AND SKIN CANCER INC

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	:	1316201726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON DERMATOLOGY AND SKIN CANCER INC

Provider Business Mailing Address
First Line	:	PO BOX 496084
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96049-6084
Country	:	US
Telephone Number	:	702-558-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 SAINT ROSE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89052-4447
Country	:	US
Telephone Number	:	702-558-5100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL TAHERI
Credential	:	MD
Telephone Number	:	702-558-5100

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	07/02/2012

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