Provider Demographics
NPI:1881023927
Name:ADVANCED DERMATOLOGY & SKIN CANCER SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY & SKIN CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-303-6900
Mailing Address - Street 1:31720 TEMECULA PKWY
Mailing Address - Street 2:SUITE #203
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5802
Mailing Address - Country:US
Mailing Address - Phone:951-303-6900
Mailing Address - Fax:951-303-2900
Practice Address - Street 1:31720 TEMECULA PKWY
Practice Address - Street 2:SUITE #203
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5802
Practice Address - Country:US
Practice Address - Phone:951-303-6900
Practice Address - Fax:951-303-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty