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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207N00000X | Dermatology | | G70359 | CALIFORNIA | No |
| 2 | 207ND0101X | Dermatology | MOHS-Micrographic Surgery | G70359 | CALIFORNIA | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1100206 | MEDICARE PIN | IDAHO | |
| 2 | 11002060 | MEDICARE PIN | IDAHO | |
| 3 | WG70359V | MEDICARE PIN | CALIFORNIA | |
| 4 | WG70359X | MEDICARE PIN | CALIFORNIA | |
| 5 | 00G703592 | OTHER | CALIFORNIA | INDIVIDUAL PTAN NO. CA. |
| 6 | AO348Z | MEDICARE PIN | CALIFORNIA | |
| 7 | WG70359Y | MEDICARE PIN | CALIFORNIA | |
| 8 | 00G703594 | MEDICARE UPIN | CALIFORNIA | |
| 9 | 00G703596 | MEDICARE UPIN | CALIFORNIA | |
| 10 | 00G703598 | MEDICARE PIN | CALIFORNIA | |
| 11 | AQ348Z -- NRTHRN CA | MEDICARE PIN | CALIFORNIA | |
| 12 | WG70359P | MEDICARE PIN | CALIFORNIA | |
| 13 | WG70359S | MEDICARE PIN | CALIFORNIA | |
| 14 | WG70359M | MEDICARE PIN | CALIFORNIA | |
| 15 | WG70359W | MEDICARE PIN | CALIFORNIA | |
| 16 | Z130600 | MEDICARE PIN | ARIZONA | |
| 17 | Z131415 | MEDICARE PIN | ARIZONA | |
| 18 | WG70359L | MEDICARE PIN | CALIFORNIA | |
| 19 | P00369772 | OTHER | ARIZONA | RAILROAD MEDICARE |
| 20 | F08741 | MEDICARE UPIN | CALIFORNIA | |
| 21 | 00G703595 | MEDICARE UPIN | CALIFORNIA | |
| 22 | 00G703593 | MEDICARE PIN | CALIFORNIA | |
| 23 | 00G703597 | MEDICARE PIN | CALIFORNIA | |
| 24 | 109455 | MEDICARE PIN | ARIZONA | |
| 25 | 120638 | MEDICARE PIN | ARIZONA | |
| 26 | 070016367 | OTHER | CALIFORNIA | RR MEDICARE FOR NORTHERN CALIF |
| 27 | 00G703590 | MEDICARE PIN | CALIFORNIA | |
| 28 | WG70359U | MEDICARE PIN | CALIFORNIA | |
| 29 | WG70359T | MEDICARE PIN | CALIFORNIA | |