Provider Demographics
NPI:1346544525
Name:ADVANCED SKIN CARE AND DERMATOLOGY PHYSICIANS OF NORTHERN CALIFORNIA,
Entity Type:Organization
Organization Name:ADVANCED SKIN CARE AND DERMATOLOGY PHYSICIANS OF NORTHERN CALIFORNIA,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-829-5778
Mailing Address - Street 1:7064 CORLINE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4528
Mailing Address - Country:US
Mailing Address - Phone:707-829-5778
Mailing Address - Fax:707-829-7629
Practice Address - Street 1:7064 CORLINE CT
Practice Address - Street 2:SUITE C
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4528
Practice Address - Country:US
Practice Address - Phone:707-829-5778
Practice Address - Fax:707-829-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty