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WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION NPI 1326119165


NPI Information

NPI: 1326119165
Provider Name: WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION

Doing Business As: BEACH CITIES DEMATOLOGY MED CENTER

Classification: Dermatology - 207N00000X
Entity Type: Organization
Address:
520 N PROSPECT AVE
STE 302
REDONDO BEACH, CA
ZIP 90277
Phone: (310) 798-1515
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WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION is a dermatology in Redondo Beach, 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. WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION NPI is 1326119165. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Beach Cities Dematology Med Center.

The provider's business location address is:

520 N PROSPECT AVE
STE 302
REDONDO BEACH, CA
ZIP 90277-041
Phone: (310) 798-1515
Fax: (310) 798-3131

The provider's authorized official is Neal M Ammar .
The authorized official title is Ceo and has the following contact phone number (310) 798-1515.

The enumeration date for this NPI number is 11/13/2006 and was last updated on 3/24/2022.


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
1207N00000XDermatologyG650830CALIFORNIAYes

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
100G650830OTHERCALIFORNIAMEDICARE NORTHERN CA ID
200G650830MEDICAIDCALIFORNIA

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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