| NPI | 1407973738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA REID Billing Manager 310-854-3003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G37913) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2026-08-20 |