Provider Demographics
NPI:1407474273
Name:GOOD DERM, INC
Entity Type:Organization
Organization Name:GOOD DERM, INC
Other - Org Name:GOOD DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-655-8058
Mailing Address - Street 1:3640 LOMITA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3956
Mailing Address - Country:US
Mailing Address - Phone:310-405-0693
Mailing Address - Fax:
Practice Address - Street 1:3640 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3956
Practice Address - Country:US
Practice Address - Phone:310-405-0693
Practice Address - Fax:310-356-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689963340OtherINDIVIDUAL NPI FOR CONSUELO VERA DAVID, MD
1750351193OtherINDIVIDUAL NPI FOR NOAH CRAFT, MD