Provider Demographics
NPI:1548773286
Name:ZAND DERMATOLOGY INC
Entity Type:Organization
Organization Name:ZAND DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCRETIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-925-0550
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 246
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3055
Mailing Address - Country:US
Mailing Address - Phone:415-301-5000
Mailing Address - Fax:844-719-5148
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 246
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3055
Practice Address - Country:US
Practice Address - Phone:415-301-5000
Practice Address - Fax:844-719-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97783207N00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty