Basic Information
| Provider Information | |||||||||
| NPI: | 1598136384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAMOND BAR DERMATOLOGY AND LASER CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 S ARROYO PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268443884 | ||||||||
| FaxNumber: | 6268443886 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 GRAND AVE | ||||||||
| Address2: | SUITE K | ||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917654171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098604254 | ||||||||
| FaxNumber: | 9098602674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | RIGOR | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6268443884 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A92405 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.