Provider Demographics
NPI:1790516623
Name:MPZ DERMATOLOGY
Entity type:Organization
Organization Name:MPZ DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:909-227-8034
Mailing Address - Street 1:5357 VIA MORENA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5007
Mailing Address - Country:US
Mailing Address - Phone:909-227-8034
Mailing Address - Fax:
Practice Address - Street 1:1820 FULLERTON AVE STE 360
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3106
Practice Address - Country:US
Practice Address - Phone:951-270-4494
Practice Address - Fax:951-270-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty