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SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP INC. NPI 1447334396


NPI Information

NPI: 1447334396
Provider Name: SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC.
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 05D0872622

Address:
6367 ALVARADO CT
SUITE 107
SAN DIEGO, CA
ZIP 92120
Phone: (619) 287-1882
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SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC. is a dermatology in San Diego, CA. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC. NPI is 1447334396. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6367 ALVARADO CT
SUITE 107
SAN DIEGO, CA
ZIP 92120-904
Phone: (619) 287-1882
Fax: (619) 287-4121

The provider's authorized official is Fred F Shahan .
The authorized official title is President and has the following contact phone number (619) 287-1882.

The CLIA number assigned to this NPI record is 05D0872622 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 12/26/2012.


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
1207N00000XDermatologyG83901CALIFORNIAYes

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
1G19221MEDICARE UPINCALIFORNIA
2W15141BMEDICARE PINCALIFORNIA
3W15141CMEDICARE PINCALIFORNIA
4W15141MEDICARE PINCALIFORNIA
5W15141AMEDICARE PINCALIFORNIA

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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