Provider Demographics
NPI:1588674212
Name:WEST COAST SKIN AND CANCER MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WEST COAST SKIN AND CANCER MEDICAL CENTER, INC.
Other - Org Name:WEST COAST SKIN AND CANCER MEDICAL CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DERMATOLOGYST/DERMATHOPATHOLOGYST
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-446-0285
Mailing Address - Street 1:7055 N FRESNO ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2957
Mailing Address - Country:US
Mailing Address - Phone:559-446-0285
Mailing Address - Fax:559-446-1646
Practice Address - Street 1:7055 N FRESNO ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2957
Practice Address - Country:US
Practice Address - Phone:559-446-0285
Practice Address - Fax:559-446-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98454Medicare UPIN