Provider Demographics
NPI:1164425054
Name:ESCONDIDO DERMATOLOGY, INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ESCONDIDO DERMATOLOGY, INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-747-1980
Mailing Address - Street 1:504 W MISSION AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1602
Mailing Address - Country:US
Mailing Address - Phone:760-747-1980
Mailing Address - Fax:760-747-2045
Practice Address - Street 1:504 W MISSION AVE
Practice Address - Street 2:STE 101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1602
Practice Address - Country:US
Practice Address - Phone:760-747-1980
Practice Address - Fax:760-747-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty