Provider Demographics
NPI:1285028803
Name:PALOS VERDES SKIN SURGERY CTR INC
Entity Type:Organization
Organization Name:PALOS VERDES SKIN SURGERY CTR INC
Other - Org Name:PALOS VERDES DERMATOLOGY SURGERY CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-541-7800
Mailing Address - Street 1:550 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 283
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3664
Mailing Address - Country:US
Mailing Address - Phone:310-541-7800
Mailing Address - Fax:310-541-7808
Practice Address - Street 1:550 DEEP VALLEY DR
Practice Address - Street 2:SUITE 283
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3664
Practice Address - Country:US
Practice Address - Phone:310-541-7800
Practice Address - Fax:310-541-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical