Provider Demographics
NPI:1720356827
Name:COMPREHENSIVE DERMATOLOGY OF LONG BEACH PC
Entity Type:Organization
Organization Name:COMPREHENSIVE DERMATOLOGY OF LONG BEACH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:H
Authorized Official - Last Name:JAVAHERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-256-9929
Mailing Address - Street 1:3736 ATLANTIC AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3492
Mailing Address - Country:US
Mailing Address - Phone:562-256-9929
Mailing Address - Fax:562-256-9946
Practice Address - Street 1:3736 ATLANTIC AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3492
Practice Address - Country:US
Practice Address - Phone:562-256-9929
Practice Address - Fax:562-256-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty