| NPI | 1295999274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE ICKES Practice Administrator 805-379-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CA G66971) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G66971) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA G66971) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2012-07-31 |