Basic Information
| Provider Information | |||||||||
| NPI: | 1144265893 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABLON SKIN INSTITUTE | ||||||||
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| OtherOrganizationName: | GLYNIS R. ABLON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2866 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905092866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107920601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 ROSECRANS AVE | ||||||||
| Address2: | BLDG 6A, SUITE 12 | ||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902663708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107273376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | ABLON | ||||||||
| AuthorizedOfficialFirstName: | GLYNIS | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3103766262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | G77280 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.