Provider Demographics
NPI:1275722571
Name:DERMATOLOGY AND LASER OF DEL MAR
Entity Type:Organization
Organization Name:DERMATOLOGY AND LASER OF DEL MAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-350-7546
Mailing Address - Street 1:12865 POINTE DEL MAR WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-350-7546
Mailing Address - Fax:858-350-8282
Practice Address - Street 1:12865 POINTE DEL MAR WAY STE 160
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-350-7546
Practice Address - Fax:858-350-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17280Medicare PIN