Provider Demographics
NPI:1720723448
Name:DERMATOLOGY COLLECTIVE INC
Entity Type:Organization
Organization Name:DERMATOLOGY COLLECTIVE INC
Other - Org Name:THE DERMATOLOGY COLLECTIVE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-240-2020
Mailing Address - Street 1:552 W FOOTHILL BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2470
Mailing Address - Country:US
Mailing Address - Phone:626-240-2020
Mailing Address - Fax:
Practice Address - Street 1:552 W FOOTHILL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2470
Practice Address - Country:US
Practice Address - Phone:818-795-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty