Provider Demographics
NPI:1528370343
Name:DERM EFFECTS INC.
Entity Type:Organization
Organization Name:DERM EFFECTS INC.
Other - Org Name:DERMFX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:310-863-5961
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-1440
Mailing Address - Country:US
Mailing Address - Phone:562-592-5101
Mailing Address - Fax:562-592-5950
Practice Address - Street 1:16501 PACIFIC COAST HIGHWAY
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:CA
Practice Address - Zip Code:90742
Practice Address - Country:US
Practice Address - Phone:562-592-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty