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SPADE SKIN CARE MEDICAL INC NPI 1790225829


NPI Information

NPI: 1790225829
Provider Name: SPADE SKIN CARE MEDICAL INC
Classification: Dermatology - 207N00000X
Entity Type: Organization
Address:
1611 S CATALINA AVE STE L70
REDONDO BEACH, CA
ZIP 90277
Phone: (310) 316-1954
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SPADE SKIN CARE MEDICAL INC 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. SPADE SKIN CARE MEDICAL INC NPI is 1790225829. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1611 S CATALINA AVE STE L70
REDONDO BEACH, CA
ZIP 90277-296
Phone: (310) 316-1954
Fax: (310) 504-1739

The provider's authorized official is John O'neil Simmonds .
The authorized official title is President and has the following contact phone number (310) 316-1954.

The enumeration date for this NPI number is 3/8/2017 and was last updated on 3/8/2017.


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
1207N00000XDermatologyA100364CALIFORNIAYes

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
1CB206988MEDICARE PINCALIFORNIA

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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