EL SEGUNDO DERMATOLOGY, INC. (NPI# 1619351707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619351707 |
| Entity Type | Organization |
| Organization Name | EL SEGUNDO DERMATOLOGY, INC. |
| Other Organization Name | GARDENA DERMATOLOGY |
| Practice Address |
713 N Douglas St. El Segundo CA 90245 |
| Mailing Address |
713 N. Douglas St. El Segundo CA 90245 |
| Practice Telephone | 3109062788 |
| Practice Fax Number | 3109062786 |
| Mailing Telephone | 3109062788 |
| Mailing Fax Number | 3109062786 |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2020-02-11 |
| Authorized Official Name | BRENDA FELLMAN (PRACTICE MANAGER) |
| Authorized Official Telephone | 3109062788 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 100120719 | 05 |
| Other Name | Type Code |
|---|---|
| Gardena Dermatology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1141 W Redondo Beach Blvd Ste 107, Gardena, CA 902473585 | 3109062788 | 3109062786 |
| 713 N Douglas St., El Segundo, CA 90245 | 3109062788 | 3109062786 |
| Street Address |
713 N DOUGLAS ST. |
| City | EL SEGUNDO |
| State | CA |
| Zip Code | 90245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058976 | Britt'nee Cornelius | Massage Therapist | 222 North PCh, Suite 2000, El Segundo, CA 90245 | 2020-09-18 |
| 1750913778 | Laurie Ann Scoppetto | Dietitian, Registered | 482 N Aviation Blvd, El Segundo, CA 90245 | 2020-02-07 |
| 1972135283 | A Dabrowska Dds, Inc | Dentist | 390 N. Pacific Coast Hwy #1050, El Segundo, CA 90245 | 2020-02-05 |
| 1578023057 | Miles Bertumen | Pharmacist | 283 N Aviation Blvd, Building 210, El Segundo, CA 90245 | 2019-03-21 |
| 1831673201 | Kriss L. Killam | Marriage & Family Therapist | 302 W. Grand Ave., Suite 9, El Segundo, CA 90245 | 2018-09-20 |
| 1811487911 | Bright Light Recovery | Substance Abuse Rehabilitation Facility | 218 Concord St, Suite C, El Segundo, CA 90245 | 2018-05-14 |
| 1265950448 | Sarah Yuriko Mizuki | Physician Assistant | 390 N PCh, Suite 1000, El Segundo, CA 90245 | 2017-09-07 |
| 1326586462 | Jlp Interpreting Services | Interpreter | 963 Virginia St #5, El Segundo, CA 90245 | 2017-02-09 |
| 1083956635 | 24hr Homecare, LLC | Home Health | 200 N. Pacific Coast Highway, Suite 300, El Segundo, CA 90245 | 2013-03-21 |
| 1326316720 | Kris S. Syn | Pharmacist | 331 North Sepulveda Blvd, El Segundo, CA 90245 | 2011-12-13 |
| Find all providers in zip 90245 | ||||
| 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 |
|---|---|---|---|---|
| 1871558635 | Howard Murad | Specialist | 2141 Rosecrans Ave, East Tower Suite 6100, El Segundo, CA 90245-4747 | 2006-04-17 |
| 1083608004 | Jane Alison Semel | Specialist | 390 N Sepulveda Blvd, Suite 1100, El Segundo, CA 90245-4475 | 2005-09-06 |
| 1447450432 | Patricia Elizabeth Hatchett | Specialist | 2250 Park Pl, El Segundo, CA 90245-4908 | 2007-07-19 |
| 1275601775 | Sandeep K Reddy | Specialist | 2040 E Mariposa Ave, El Segundo, CA 90245 | 2006-12-01 |
| 1831154699 | Murad Medical Group | Specialist | 2141 Rosecrans Ave, East Tower Suite 6100, El Segundo, CA 90245-4747 | 2006-04-17 |
| 1710971742 | Semel Vision Care | Specialist | 390 N Sepulveda Blvd, Suite 1100, El Segundo, CA 90245-4475 | 2005-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113072 | Jonalyn Coronel | Specialist | 653 Canyon Rd, Novato, CA 94947-4331 | 2020-10-28 |
| 1497353239 | Nadia Nodoust-christensen | Specialist | 1627 Curtis Ave, Manhattan Beach, CA 90266-7022 | 2020-10-14 |
| 1073111936 | Griffin Nutrition Xterem | Specialist | 21575 Dome Trl, Topanga, CA 90290-3645 | 2020-10-13 |
| 1811503162 | George Thomas Lafortune | Specialist | 7927 Painter Ave Ste 200, Whittier, CA 90602-2480 | 2020-09-22 |
| 1699383661 | Transgender Health and Wellness Center | Specialist | 6700 Indiana Ave Ste 252, Riverside, CA 92506-4264 | 2020-07-16 |
| 1700403524 | Kelly Phillips | Specialist | 4650 Fruitvale Rd, Newcastle, CA 95658-9240 | 2020-06-27 |
| 1417572462 | Sarah Velez | Specialist | 1001 Potrero Ave Rm 7g19, San Francisco, CA 94110-3518 | 2020-06-15 |
| 1295350668 | Bette Graff | Specialist | 4148 10th St, Riverside, CA 92501-3110 | 2020-06-11 |
| 1114541463 | Serena Mink | Specialist | 100 Park Plz Apt 407, San Diego, CA 92101-6710 | 2020-06-02 |
| 1811510043 | Michael J Kodrich | Specialist | 40555 California Oaks Rd, Murrieta, CA 92562-5723 | 2020-05-21 |
| Find all providers with the same taxonomy | ||||
| City | EL SEGUNDO |
| Zip Code | 90245 |
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| 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.