Provider Demographics
NPI:1326427204
Name:JENNIFER HERRMANN MD INC
Entity Type:Organization
Organization Name:JENNIFER HERRMANN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROCEDURAL DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-285-6606
Mailing Address - Street 1:13603 MARINA POINTE DR
Mailing Address - Street 2:APT B516
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5583
Mailing Address - Country:US
Mailing Address - Phone:646-285-6606
Mailing Address - Fax:
Practice Address - Street 1:421 N RODEO DR STE 7
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4514
Practice Address - Country:US
Practice Address - Phone:310-274-5372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-25
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130259207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty