Provider Demographics
NPI:1508815556
Name:ISLAND DERMATOLOGY, INC
Entity Type:Organization
Organization Name:ISLAND DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINACIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-720-1170
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-720-1170
Mailing Address - Fax:949-720-1172
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 501
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-720-1170
Practice Address - Fax:949-720-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty