Provider Demographics
NPI:1770025207
Name:CYPRESS DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:CYPRESS DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-528-8818
Mailing Address - Street 1:310 PAUL REVERE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27700 NORTHWEST FWY
Practice Address - Street 2:SUITE 490
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6766
Practice Address - Country:US
Practice Address - Phone:713-528-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty