Provider Demographics
NPI:1598136384
Name:DIAMOND BAR DERMATOLOGY AND LASER CENTER
Entity Type:Organization
Organization Name:DIAMOND BAR DERMATOLOGY AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:RIGOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-844-3884
Mailing Address - Street 1:675 S ARROYO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3263
Mailing Address - Country:US
Mailing Address - Phone:626-844-3884
Mailing Address - Fax:626-844-3886
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:SUITE K
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
Practice Address - Country:US
Practice Address - Phone:909-860-4254
Practice Address - Fax:909-860-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92405207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty