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NPI Code Detail

MEDICARE: DERM LOUNGE PC

MEDICARE: DERM LOUNGE 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
1207ND0101XMOHS-Micrographic Surgery Physician
2207NS0135XProcedural Dermatology Physician
3208D00000XGeneral Practice Physician
4207N00000XDermatology Physician

General Provider Information

NPI Number : 1962260208
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERM LOUNGE PC
Provider Business Mailing Address
First Line : PO BOX 519
Second Line :
City : LAKE FOREST
State : CA
Zip : 92609-0519
Country : US
Telephone Number : 714-798-2900
Fax Number : 949-216-3232
Provider Business Practice Location Address
First Line : 1713 W KATELLA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92804-6450
Country : US
Telephone Number : 714-798-2900
Fax Number : 949-216-3232
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MR. FARAH AWADALLA
Credential :
Telephone Number : 714-337-9393
Provider Enumeration Date : 03/11/2024
Last Update Date : 05/27/2025

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Directions to “DERM LOUNGE PC ” Practice Location

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