| NPI | 1932154788 |
|---|---|
| Doing Business As | SOUTHERN CALIFORNIA DERMATOLOGY |
| Doing Business As | WEST DERMATOLOGY AND SURGERY MEDICAL GROUP |
| Doing Business As | WEST DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | LUCIUS BLANCHARD Owner/Physician 702-360-2763 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G4302) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA C53342) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: CA G4302) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: CA C53342) | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2025-01-21 |