GOLDEN STATE DERMATOLOGY ASSOCIATES, INC. (NPI# 1700860871) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700860871 |
| Entity Type | Organization |
| Organization Name | GOLDEN STATE DERMATOLOGY ASSOCIATES, INC. |
| Practice Address |
355 Lennon Ln Ste 255 Walnut Creek CA 94598-2496 |
| Mailing Address |
370 N Wiget Ln Ste 250 Walnut Creek CA 94598-2488 |
| Practice Telephone | 9259327704 |
| Practice Fax Number | 9259327752 |
| Mailing Telephone | 9259457005 |
| Mailing Fax Number | 9259541822 |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2019-08-22 |
| Authorized Official Name | DR. JEFFREY THOMAS BORTZ (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9259327704 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DEA | BB2515394 | 01 |
| CA | CLIA NUMBER | 05D096539 | 01 |
| CA | LICENSE | A487440 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1000 Delbon Ave Ste 8, Turlock, CA 953822008 | 2097227801 | |
| 1058 Murrieta Blvd, Livermore, CA 945504111 | 9252771300 | |
| 1200 Central Blvd Ste D, Brentwood, CA 945132227 | 9253089510 | |
| 1324 Nelson Ave, Modesto, CA 953505374 | 2095249481 | |
| 1542 N Tracy Blvd # A, Tracy, CA 953762903 | 2098362220 | |
| 2255 Ygnacio Valley Rd Ste B1, Walnut Creek, CA 945983335 | 9259457005 | |
| 280 Baldwin Ave, San Mateo, CA 944013915 | 6507276008 | |
| 410 E Yosemite Ave Ste C, Merced, CA 953408220 | 2097227801 | |
| 5201 Norris Canyon Rd, San Ramon, CA 945835411 | 9252771300 | |
| 5575 W Las Positas Blvd Ste 260, Pleasanton, CA 945885803 | 9258473020 | |
| 5640 N Fresno St Ste 110, Fresno, CA 937106098 | 5592669906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235738576 | Golden State Dermatology Associates, Inc. | Clinic/Center | 6769 N Fresno St, Fresno, CA 93710-3715 | 2020-10-19 |
| Street Address |
355 LENNON LN STE 255 |
| City | WALNUT CREEK |
| State | CA |
| Zip Code | 94598-2496 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982267290 | Elaine Rotha Lim | Physician Assistant | 355 Lennon Ln Ste 255, Walnut Creek, CA 94598 | 2019-04-22 |
| 1023405727 | Grace Kim Sohn | Dermatology | 355 Lennon Ln Ste 255, Walnut Creek, CA 94598-2496 | 2015-04-20 |
| 1134373392 | Nicole Ramos Petro | Physician Assistant | 355 Lennon Ln Ste 255, Walnut Creek, CA 94598 | 2008-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639716608 | Tasnim Diaf Moulton | Counselor | 2730 Shadelands Drive, Walnut Creek, CA 94598 | 2019-12-09 |
| 1790255370 | Harmony Grace Davis | Behavior Technician | 2730 Shadelands Drive Bldg 10, Walnut Creek, CA 94598 | 2018-11-27 |
| 1922583772 | Melissa Anne Mcgovern | Behavioral Analyst | 2370 Shadelands Drive, Bldg 10, Walnut Creek, CA 94598 | 2018-09-27 |
| 1184108367 | Brett Heflin Woodrufff | Behavior Technician | 2730 Shandeland Dr. Building 10, Walnut Creek, CA 94598 | 2018-09-24 |
| 1710411640 | Mandy Wei | Pharmacist | 2880 Shadeland Dr, Suite 201, Walnut Creek, CA 94598 | 2017-04-18 |
| 1437683497 | Hayley Miller | Student in an Organized Health Care Education/Training Program | 2204 Lomond Lane, Walnut Creek, CA 94598 | 2017-04-17 |
| 1043601594 | Marlene Perez Riedel | Nurse Practitioner | 450 North Wiget Lane, Walnut Creek, CA 94598 | 2015-02-05 |
| 1922418904 | Dante Michael Sorrentino | Ophthalmology | Kaiser Permanente Park Shadelands Medical Offices, 320 Lennon Lane, Walnut Creek, CA 94598 | 2014-04-30 |
| 1194156505 | Robert Harrison Hubbell | Obstetrics & Gynecology | 838 Stonehaven Dr, Walnut Creek, CA 94598 | 2013-12-11 |
| 1174954192 | Paul Mead | Orthopaedic Surgery | 2405 Shadelands Dr Ste 300, Walnut Creek, CA 94598 | 2013-12-01 |
| Find all providers in zip 94598 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225222128 | Christina Daria Fonseca | Dermatology | 320 Lennon Lane Kaiser Permanente Medical Group, Department of Dermatology, Walnut Creek, CA 94598 | 2007-09-04 |
| 1477650372 | Alexander Lewis IIi | Dermatology | 1820 San Miguel Dr, Walnut Creek, CA 94596 | 2006-09-20 |
| 1396789731 | Jay William Zimmerman | Dermatology | 2255 Ygnacio Valley Rd Ste B1, Walnut Creek, CA 94598-3335 | 2006-06-16 |
| 1124014741 | Min-wei Christine Lee | Dermatology | 370 N Wiget Ln, Ste 125, Walnut Creek, CA 94598-2546 | 2005-09-20 |
| 1023405727 | Grace Kim Sohn | Dermatology | 355 Lennon Ln Ste 255, Walnut Creek, CA 94598-2496 | 2015-04-20 |
| 1245644657 | Joy Makdisi | Dermatology | 2255 Ygnacio Valley Rd Ste B1, Walnut Creek, CA 94598-3335 | 2014-06-13 |
| 1407285240 | Golden State Dermatology, Inc. | Dermatology | 2255 Ygnacio Valley Rd Ste B1, Walnut Creek, CA 94598-3335 | 2013-11-02 |
| 1437491743 | Jerral S Seibert M D Inc | Dermatology | 1220 Rossmoor Pkwy, Walnut Creek, CA 94595-2501 | 2013-03-25 |
| 1790927655 | Daniel J. Wall M.d., Inc | Dermatology | 110 La Casa Via, Suite 205, Walnut Creek, CA 94598-3088 | 2009-03-24 |
| 1861672800 | Marvin L Engel Md Inc | Dermatology | 130 La Casa Via, Bldg 2 Suite 110, Walnut Creek, CA 94598-3045 | 2007-11-07 |
| Find all providers in WALNUT CREEK | ||||
| City | WALNUT CREEK |
| Zip Code | 94598 |
Please comment or provide details below to improve the information on GOLDEN STATE DERMATOLOGY ASSOCIATES, INC..
| 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.