| NPI | 1346262375 |
|---|---|
| Doing Business As | MIRAGE DERMATOLOGY MEDICAL ASSOCIATES, INC. |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY RICHARDSON President 760-341-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA g53073) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-06-28 |