| NPI | 1568431500 |
|---|---|
| Former Legal Business Name | SAN LUIS DERMATOLOGY & LASER CLINIC INC |
| Former Legal Business Name | R JEFFREY HERTEN MD A MEDICAL CORPORATION |
| Entity Type | Organization |
| Authorized Contact | MARY TOLBERT Practice Manager 805-541-2650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-06-26 |