Organization · NPI-2
Diamond Bar Dermatology And Laser Center
Dermatology · Diamond Bar, CA
NPI number1598136384
StatusActive
Last updated in NPPESJun 29, 2020
Details
- NPI
- 1598136384
- Entity type
- Organization (NPI-2)
- Legal business name
- Diamond Bar Dermatology And Laser Center
- Organization subpart
- No
- Enumeration date
- Oct 19, 2015
- Certification date
- Jun 29, 2020
- Last updated
- Jun 29, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | A92405 | CA | Yes |
Practice location
1111 Grand AveSuite K
Diamond Bar, CA 91765-4171
Phone 909-860-4254 · Fax 909-860-2674
Mailing address
675 S Arroyo PkwySuite 100
Pasadena, CA 91105-3263
Phone 626-844-3884 · Fax 626-844-3886
Authorized official
Ronald O Rigor
Owner/Provider
6268443884
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