Blue Harbor Dermatology INC
Dermatology in Newport Beach, CA. Organization (NPI-2).
NPI number1962829457
StatusActive
Last updated in NPPESMar 24, 2014
Details
- NPI
- 1962829457
- Entity type
- Organization (NPI-2)
- Legal business name
- Blue Harbor Dermatology INC
- Organization subpart
- No
- Enumeration date
- Mar 24, 2014
- Last updated
- Mar 24, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 20A12076 | CA | Yes |
Practice location
1501 Superior AveSuite 115
Newport Beach, CA 92663-3600
Phone 214-395-2221
Mailing address
1501 Superior AveSuite 115
Newport Beach, CA 92663-3600
Authorized official
Kevin Belasco
Physician
8008282012
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