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GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION NPI 1821116054


NPI Information

NPI: 1821116054
Provider Name: GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D0686223

Address:
24411 HEALTH CENTER DR STE 520
LAGUNA HILLS, CA
ZIP 92653
Phone: (949) 452-3841
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GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION is a specialist in Laguna Hills, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION NPI is 1821116054. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

24411 HEALTH CENTER DR STE 520
LAGUNA HILLS, CA
ZIP 92653-633
Phone: (949) 452-3841
Fax: (949) 859-8937

The provider's authorized official is Rollin M Green .
The authorized official title is President and has the following contact phone number (949) 452-3841.

The CLIA number assigned to this NPI record is 05D0686223 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/26/2007 and was last updated on 5/4/2018.


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
1174400000XSpecialistYes

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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