Provider Demographics
NPI:1821884610
Name:CPP 435SKIN PC
Entity type:Organization
Organization Name:CPP 435SKIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-892-2030
Mailing Address - Street 1:1125 E SPRUCE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3390
Mailing Address - Country:US
Mailing Address - Phone:559-435-7546
Mailing Address - Fax:559-435-4976
Practice Address - Street 1:1125 E SPRUCE AVE STE 207
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3390
Practice Address - Country:US
Practice Address - Phone:559-435-7546
Practice Address - Fax:559-435-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty