Provider Demographics
NPI:1356094676
Name:DERMATOLOGY SPA MED INC
Entity Type:Organization
Organization Name:DERMATOLOGY SPA MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CABEZZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-327-4499
Mailing Address - Street 1:6000 PHYSICIANS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1215
Mailing Address - Country:US
Mailing Address - Phone:661-327-4499
Mailing Address - Fax:661-215-6387
Practice Address - Street 1:300 JAMES WAY STE 140
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2874
Practice Address - Country:US
Practice Address - Phone:805-574-1000
Practice Address - Fax:805-574-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty