Provider Demographics
NPI:1225674450
Name:DESERT DERMATOLOGY & SKIN CANCER SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:DESERT DERMATOLOGY & SKIN CANCER SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-822-5969
Mailing Address - Street 1:31938 TEMECULA PKWY STE A337
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6810
Mailing Address - Country:US
Mailing Address - Phone:714-822-5969
Mailing Address - Fax:951-303-2900
Practice Address - Street 1:1400 N GILBERT RD STE L
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2327
Practice Address - Country:US
Practice Address - Phone:714-822-5969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty