Provider Demographics
NPI:1285208538
Name:RM GREEN DERMATOLOGY OF LAGUNA HILLS INC
Entity Type:Organization
Organization Name:RM GREEN DERMATOLOGY OF LAGUNA HILLS INC
Other - Org Name:ROLLIN M. GREEN, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-452-3841
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 520
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-452-3841
Mailing Address - Fax:949-859-8937
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7624
Practice Address - Country:US
Practice Address - Phone:949-452-3841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty