MEDICARE: PIMPLE POPPER MD, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952915068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIMPLE POPPER MD, INC.

Provider Business Mailing Address
First Line	:	1669 LAS CANOAS RD
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-2364
Country	:	US
Telephone Number	:	661-993-2479
Fax Number	:	805-244-2568

Provider Business Practice Location Address
First Line	:	601 E ARRELLAGA ST STE 101
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-2275
Country	:	US
Telephone Number	:	805-944-1130
Fax Number	:	805-244-2568

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	RIKK LYNN
Credential	:	MD
Telephone Number	:	805-944-1130

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/12/2020

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Directions to “PIMPLE POPPER MD, INC. ” Practice Location

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