Provider Demographics
NPI:1043804784
Name:PRIMARY CARE SKIN SOLUTIONS & PSORIASIS TREATMENT INC
Entity Type:Organization
Organization Name:PRIMARY CARE SKIN SOLUTIONS & PSORIASIS TREATMENT INC
Other - Org Name:PRIMARY SKIN CARE SOLUTIONS & PSORIASIS TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-328-2141
Mailing Address - Street 1:16501 WALNUT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3684
Mailing Address - Country:US
Mailing Address - Phone:909-328-2141
Mailing Address - Fax:909-328-2289
Practice Address - Street 1:16501 WALNUT ST STE 11
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3684
Practice Address - Country:US
Practice Address - Phone:909-328-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty