1174681720 NPI number — SKIN CANCER AND RECONSTRUCTIVE SURGERY SPECIALIST OF BEVERLY HILLS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174681720 NPI number — SKIN CANCER AND RECONSTRUCTIVE SURGERY SPECIALIST OF BEVERLY HILLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKIN CANCER AND RECONSTRUCTIVE SURGERY SPECIALIST OF BEVERLY HILLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174681720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9001 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-8885
Provider Business Mailing Address Fax Number:
310-273-8662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 PALMDALE BLVD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-267-1900
Provider Business Practice Location Address Fax Number:
661-267-0700
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMMAR
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-267-1900

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A92792 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207NP0225X , with the licence number: A92792 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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