Provider Demographics
NPI:1790973162
Name:WILLIAM F RESH MD, SKIN & SKIN CANCER MEDICAL GROUP OF SAN DIEGO, INC.
Entity Type:Organization
Organization Name:WILLIAM F RESH MD, SKIN & SKIN CANCER MEDICAL GROUP OF SAN DIEGO, INC.
Other - Org Name:SAN DIEGO FAMILY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:RESH
Authorized Official - Last Name:SATEESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-267-8303
Mailing Address - Street 1:655 EUCLID AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2974
Mailing Address - Country:US
Mailing Address - Phone:619-267-8303
Mailing Address - Fax:619-267-4835
Practice Address - Street 1:655 EUCLID AVE STE 304
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2974
Practice Address - Country:US
Practice Address - Phone:619-267-8303
Practice Address - Fax:619-267-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C346610Medicaid
CA00C346610Medicaid
CAW4266Medicare PIN