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GOLDEN COAST DERMATOLOGY SKIN CANCER AND VEIN CENTER PC NPI 1053957456


NPI Information

NPI: 1053957456
Provider Name: GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 05D2182444

Address:
26732 CROWN VALLEY PKWY STE 571
MISSION VIEJO, CA
ZIP 92691
Phone: (270) 933-2109
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GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC is a mohs-micrographic surgery dermatology in Mission Viejo, CA. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC NPI is 1053957456. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

26732 CROWN VALLEY PKWY STE 571
MISSION VIEJO, CA
ZIP 92691-305
Phone: (270) 933-2109

The provider's authorized official is William Tidwell .
The authorized official title is Owner/physician and has the following contact phone number (270) 933-2109.

The CLIA number assigned to this NPI record is 05D2182444 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/20/2019 and was last updated on 3/27/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1A147575OTHERCALIFORNIACA STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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