Provider Demographics
NPI:1467794842
Name:COMPLETE DERMATOLOGY
Entity Type:Organization
Organization Name:COMPLETE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CARCAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-290-4371
Mailing Address - Street 1:590 FARRINGTON HWY
Mailing Address - Street 2:#524-204
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:808-621-1000
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-621-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty