| NPI | 1811497928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN VINE Md 818-789-6296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA C53733) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2019-03-25 |