| NPI | 1154609584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN NEIL LEDESMA Owner/ Medical Director 310-360-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G44761) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2011-08-02 |