Provider Demographics
NPI:1326342775
Name:DEL AMO DERMATOLOGY A MEDICAL CORP
Entity Type:Organization
Organization Name:DEL AMO DERMATOLOGY A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-543-2662
Mailing Address - Street 1:21320 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21320 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 127
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5606
Practice Address - Country:US
Practice Address - Phone:310-543-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty