Provider Demographics
NPI:1023372455
Name:RIDGECREST DERMATOLOGY AND SKIN CANCER PC
Entity Type:Organization
Organization Name:RIDGECREST DERMATOLOGY AND SKIN CANCER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-446-9007
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:760-446-9007
Mailing Address - Fax:760-446-6900
Practice Address - Street 1:1535 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2667
Practice Address - Country:US
Practice Address - Phone:760-446-9007
Practice Address - Fax:760-446-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty