Provider Demographics
NPI:1316201726
Name:HENDERSON DERMATOLOGY AND SKIN CANCER INC
Entity Type:Organization
Organization Name:HENDERSON DERMATOLOGY AND SKIN CANCER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-558-5100
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:702-558-5100
Mailing Address - Fax:
Practice Address - Street 1:2960 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4447
Practice Address - Country:US
Practice Address - Phone:702-558-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty