Organization · NPI-2
Dermesurge INC
Dermatology · Diamond Bar, CA
NPI number1538743752
StatusActive
Last updated in NPPESSep 10, 2023
Details
- NPI
- 1538743752
- Entity type
- Organization (NPI-2)
- Legal business name
- Dermesurge INC
- Organization subpart
- No
- Enumeration date
- May 12, 2021
- Certification date
- Sep 10, 2023
- Last updated
- Sep 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
Practice location
1111 Grand Ave Ste KDiamond Bar, CA 91765-4172
Phone 909-860-4254
Mailing address
1111 Grand Ave Ste KDiamond Bar, CA 91765-4172
Phone 190-986-0425
Other practice locations
175 S Harbor Blvd
Anaheim, CA 92805
Anaheim, CA 92805
Phone 909-860-4254
Authorized official
Sam Abaza
Owner
8187268722
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