| NPI | 1700371275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVIKA ICECREAMWALA Authorized Official 510-646-8070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-07-02 |