| NPI | 1407883770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN NEIL LEDESMA Owner 310-360-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA g44761) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA g44761) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA g44761) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA g44761) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA g44761) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA g44761) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-08-22 |