Provider Demographics
NPI:1841864535
Name:SKIN AND CANCER INSTITUTE TRAVIS PA
Entity type:Organization
Organization Name:SKIN AND CANCER INSTITUTE TRAVIS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-388-5240
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5302
Practice Address - Country:US
Practice Address - Phone:661-388-5240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty