Provider Demographics
NPI:1881619500
Name:THE FAMILY SKIN THERAPY CENTER AT ON THE BEACH, INC.
Entity type:Organization
Organization Name:THE FAMILY SKIN THERAPY CENTER AT ON THE BEACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-766-4247
Mailing Address - Street 1:10660 RIVERSIDE DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2352
Mailing Address - Country:US
Mailing Address - Phone:818-766-4247
Mailing Address - Fax:818-506-1259
Practice Address - Street 1:10660 RIVERSIDE DR
Practice Address - Street 2:UNIT D
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2352
Practice Address - Country:US
Practice Address - Phone:818-766-4247
Practice Address - Fax:818-506-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty