Provider Demographics
NPI:1033964374
Name:COLLO ROSSO DERMATOLOGY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COLLO ROSSO DERMATOLOGY, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-880-8676
Mailing Address - Street 1:941 ORANGE AVE # 1012
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2609
Mailing Address - Country:US
Mailing Address - Phone:619-880-8676
Mailing Address - Fax:
Practice Address - Street 1:7334 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5141
Practice Address - Country:US
Practice Address - Phone:619-880-8676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty