Provider Demographics
NPI:1154834992
Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER
Entity Type:Organization
Organization Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-423-4043
Mailing Address - Street 1:42600 MIRAGE RD BLDG A1
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4127
Mailing Address - Country:US
Mailing Address - Phone:760-423-4000
Mailing Address - Fax:760-318-8103
Practice Address - Street 1:46080 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4401
Practice Address - Country:US
Practice Address - Phone:760-423-4000
Practice Address - Fax:760-318-8103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-15
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty