DERMATOLOGY&LASER CENTER OF SAN DIEGO (NPI# 1457396178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457396178 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY&LASER CENTER OF SAN DIEGO |
| Practice Address |
319 F St 102 Chula Vista CA 91910-2666 |
| Practice Telephone | 6194761200 |
| Practice Fax Number | 6194207849 |
| Mailing Telephone | 6194761200 |
| Mailing Fax Number | 6194207849 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2011-11-22 |
| Authorized Official Name | MISS SARA ROSALES (INSURANCE SPECIALIST) |
| Authorized Official Telephone | 6194761200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | C36597 | CA | Other Service Providers |
| N | 174400000X | Specialist | A69750 | CA | Other Service Providers |
| N | 174400000X | Specialist | A94658 | CA | Other Service Providers |
| Y | 174400000X | Specialist | A78399 | CA | Other Service Providers |
| Street Address |
319 F ST 102 |
| City | CHULA VISTA |
| State | CA |
| Zip Code | 91910-2666 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215931993 | Mark Andrew Willoughby | Dermatology | 319 F St, Ste 102, Chula Vista, CA 91910-2666 | 2005-06-09 |
| 1306200043 | Bonita Homecare, Inc. | Home Health | 319 F St, Suite 205, Chula Vista, CA 91910-2666 | 2016-04-08 |
| 1366795825 | Cecilio Emanuel Crosby | Home Health | 319 F St, Suite 205, Chula Vista, CA 91910-2666 | 2012-10-22 |
| 1508139189 | Cecilio Emanuel Crosby | Home Health | 319 F St, Suite 205, Chula Vista, CA 91910-2666 | 2012-02-13 |
| 1659375301 | Cole Bradford Willoughby | Dermatology | 319 F St, Ste 102, Chula Vista, CA 91910-2666 | 2005-06-10 |
| 1033113725 | Erick Alfonso Mafong | Dermatology | 319 F St, Ste 102, Chula Vista, CA 91910-2666 | 2005-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477194264 | Joshua Maurice Hayden | Dental Hygienist | 678 Thrid Ave, Chula Vista, CA 91910 | 2019-10-02 |
| 1255980504 | Samantha Bernaldo | Dental Hygienist | 668 Third Ave, Chula Vista, CA 91910 | 2019-09-10 |
| 1073179529 | Roshni Kakaiya | Student in an Organized Health Care Education/Training Program | 435 H Street, Cv112, Chula Vista, CA 91910 | 2019-05-09 |
| 1598232506 | Naria Le Mire | Dietitian, Registered | 288 Broadway #141a, Chula Vista, CA 91910 | 2018-10-28 |
| 1730676727 | Pei Chi Chain | Optometrist | 324 F Street., Chula Vista, CA 91910 | 2018-04-16 |
| 1104332741 | Teodoro David Pena | Dentist | 510 Broadway Ste 4-5, Chula Vista, CA 91910 | 2017-12-19 |
| 1538684865 | Camille Cooke | Counselor | 430 F. Street, Chula Vista, CA 91910 | 2017-08-08 |
| 1184146094 | Alexandra Lynn Scovill | Optometrist | Castillejos Eye Institute Medical Group, 342 F Street, Chula Vista, CA 91910 | 2017-07-12 |
| 1396270583 | Tam Trieu | Pharmacist | 555 Broaway Suite 1054, Chula Vista, CA 91910 | 2017-04-25 |
| 1548792815 | Sabrina Owens | Family Medicine | 499 H Street Cv112, Chula Vista, CA 91910 | 2017-03-28 |
| Find all providers in zip 91910 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396296539 | Esteban Monge | Specialist | 1489 Taber Dr, Chula Vista, CA 91911-7037 | 2016-10-24 |
| 1871971853 | Miriam Minerva Nino | Specialist | 1468 S Creekside Dr, Chula Vista, CA 91915-1563 | 2015-05-11 |
| 1871929455 | Jean-michel Balensi | Specialist | 280 Landis Ave, Chula Vista, CA 91910-2627 | 2013-09-16 |
| 1346514965 | Caleb Dominguez | Specialist | 1009 Oak Hill Dr, Chula Vista, CA 91915-1409 | 2012-02-29 |
| 1730478512 | Juana Hortencia Hernandez | Specialist | 333 H St Ste 5065, Chula Vista, CA 91910-5555 | 2011-04-01 |
| 1376870014 | Ruben Eustaquio Siasoco | Specialist | 1129 Pacifica Ave, Chula Vista, CA 91913-1552 | 2009-11-16 |
| 1588899512 | Erick H. Alayo Medical Corporation | Specialist | 353 Church Ave, Suite A, Chula Vista, CA 91910-3906 | 2009-05-19 |
| 1366617540 | Angela Anita Rackley | Specialist | 178 Eckman Ct, Chula Vista, CA 91911-5203 | 2008-04-28 |
| 1801075643 | Daniel B Cullan II Md Inc | Specialist | 955 Lane Ave Ste 200, Chula Vista, CA 91914-4525 | 2007-10-29 |
| 1326101247 | Robin Victor Smith | Specialist | 450 4th Ave Ste 402, Chula Vista, CA 91910-4430 | 2006-12-19 |
| Find all providers in CHULA VISTA | ||||
| City | CHULA VISTA |
| Zip Code | 91910 |
Please comment or provide details below to improve the information on DERMATOLOGY&LASER CENTER OF SAN DIEGO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.