Basic Information
| Provider Information | |||||||||
| NPI: | 1740470053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKIN SURGERY CENTER, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 267 W HILLCREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054971694 | ||||||||
| FaxNumber: | 8054494184 | ||||||||
| Practice Location | |||||||||
| Address1: | 267 W HILLCREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054971694 | ||||||||
| FaxNumber: | 8054494184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 03/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | KAUFMAN | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8054971694 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.