Provider Demographics
NPI:1790322063
Name:MFC DERMATOLOGY
Entity Type:Organization
Organization Name:MFC DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-534-9100
Mailing Address - Street 1:3655 LOMITA BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-1918
Mailing Address - Country:US
Mailing Address - Phone:310-373-0515
Mailing Address - Fax:310-373-0516
Practice Address - Street 1:3655 LOMITA BLVD STE 221
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1918
Practice Address - Country:US
Practice Address - Phone:310-373-0515
Practice Address - Fax:310-373-0516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MFC DERMATOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912097775OtherNPI
CA1114983467OtherNPI
CA1548416019OtherNPI