Provider Demographics
NPI:1639368368
Name:HUNTINGTON BEACH DERMATOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:HUNTINGTON BEACH DERMATOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-848-0770
Mailing Address - Street 1:8101 NEWMAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7042
Mailing Address - Country:US
Mailing Address - Phone:714-848-0770
Mailing Address - Fax:714-848-6643
Practice Address - Street 1:8101 NEWMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7042
Practice Address - Country:US
Practice Address - Phone:714-848-0770
Practice Address - Fax:714-848-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG237020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG23702Medicare PIN