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05D0567864 CLIA NUMBER - GROSSMONT DERMATOLOGY MEDICAL CLINIC DBA: DERMATOLOGY MEDICAL CENTER OF CALIFORNIA

Laboratory Demographics

CLIA Number: 05D0567864

Facility Name: GROSSMONT DERMATOLOGY MEDICAL CLINIC DBA: DERMATOLOGY MEDICAL CENTER OF CALIFORNIA

Facility Address:
8860 CENTER DR STE 300
LA MESA, CA
ZIP 91942
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Facility Phone Number: 619 462-1670

Facility Type: Physician Office

Certificate Type: Certificate of Compliance
NPI Number: 1194838441

Taxonomy: 207NS0135X - Dermatology
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).

CLIA Record

Field Name Field Value
CLIA Number 05D0567864
LAB Type Physician Office
Facility Name GROSSMONT DERMATOLOGY MEDICAL CLINIC DBA: DERMATOLOGY MEDICAL CENTER OF CALIFORNIA
Street 8860 CENTER DR STE 300
City LA MESA
State CA
ZIP 91942
Phone 619 462-1670
CertificateType 2
CertificateEffectiveDate 8/24/2021
CertificateExpirationDate 4/30/2024
FacilityType Compliance

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This page was last updated on: 4/23/2024