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NPI Code Detail

MEDICARE: CITY OF ANGELS DERMATOLOGY INC

MEDICARE: CITY OF ANGELS DERMATOLOGY 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
1291U00000XClinical Medical LaboratoryCLM 000346987CA

General Provider Information

NPI Number : 1710385901
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OF ANGELS DERMATOLOGY INC
Provider Business Mailing Address
First Line : 4712 ADMIRALTY WAY # 665
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-6905
Country : US
Telephone Number : 562-366-0300
Fax Number : 562-366-7525
Provider Business Practice Location Address
First Line : 2888 LONG BEACH BLVD STE 325
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-7503
Country : US
Telephone Number : 562-366-0300
Fax Number : 562-366-7525
Authorized Official
Title or Position : DIRECTOR
Name : DR. MAVIS BILLIPS
Credential : MD
Telephone Number : 310-651-8240
Provider Enumeration Date : 12/20/2014
Last Update Date : 12/20/2014

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Directions to “CITY OF ANGELS DERMATOLOGY INC ” Practice Location

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