Provider Demographics
NPI:1689973638
Name:APEX DERMATOLOGY AND SKIN SURGERY CENTER LLC
Entity Type:Organization
Organization Name:APEX DERMATOLOGY AND SKIN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ZUAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FAAD, FACMS
Authorized Official - Phone:216-262-2777
Mailing Address - Street 1:5800 LANDERBROOK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4083
Mailing Address - Country:US
Mailing Address - Phone:440-646-1600
Mailing Address - Fax:440-646-1505
Practice Address - Street 1:7580 AUBURN ROAD, SUITE 301
Practice Address - Street 2:TRIPOINT MEDICAL CENTER, PHYSICIAN PAVILLION
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-352-7546
Practice Address - Fax:440-352-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084764207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty