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GROSSMONT DERMATOLOGY MEDICAL CLINIC NPI 1194838441


NPI Information

NPI: 1194838441
Provider Name: GROSSMONT DERMATOLOGY MEDICAL CLINIC

Doing Business As: COASTAL SKIN AND EYE INSTITUTE

Classification: Dermatology - 207NS0135X
Entity Type: Organization

Specialization: Procedural Dermatology

CLIA Number: 05D0567864

Address:
8860 CENTER DR
STE 300
LA MESA, CA
ZIP 91942
Phone: (619) 462-1670
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GROSSMONT DERMATOLOGY MEDICAL CLINIC is a procedural dermatology dermatology in La Mesa, CA. The provider is 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). GROSSMONT DERMATOLOGY MEDICAL CLINIC NPI is 1194838441. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Coastal Skin And Eye Institute.

The provider's business location address is:

8860 CENTER DR
STE 300
LA MESA, CA
ZIP 91942-068
Phone: (619) 462-1670
Fax: (619) 462-3209

The provider's authorized official is Monica Del Valle .
The authorized official title is Billing Supervisor and has the following contact phone number (619) 462-1670.

The CLIA number assigned to this NPI record is 05D0567864 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/17/2006 and was last updated on 12/27/2023.


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 SurgeryNo
2207W00000XOphthalmologyNo
3261QM1300XClinic/CenterMulti-SpecialtyNo
4207NS0135XDermatologyProcedural DermatologyYes

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
100A233400MEDICAIDCALIFORNIA
200G733400MEDICAIDCALIFORNIA

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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