Basic Information
| Provider Information | |||||||||
| NPI: | 1043613862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA DERMATOLOGY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2262 CAMINO RAMON | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253280255 | ||||||||
| FaxNumber: | 9253280257 | ||||||||
| Practice Location | |||||||||
| Address1: | 2262 CAMINO RAMON | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253280255 | ||||||||
| FaxNumber: | 9253280257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | DAO | ||||||||
| AuthorizedOfficialFirstName: | OANHTUYET | ||||||||
| AuthorizedOfficialMiddleName: | KATHY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4087848322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 51771 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.