South Bay Skin & Cancer Medical Group, Inc.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G42243 Issued in CA

Legal business name

SOUTH BAY SKIN & CANCER MEDICAL GROUP, INC.

Practice address

256 Landis Ave
Third Floor
Chula Vista, CA 91910-2650

Phone

(619) 426-9600

Fax

(619) 426-4112

NPI assigned

Nov 9, 2006

Last updated

Mar 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Peter Paul Rullan, M.D.NPI 1114963170

Title

Medical Director

Phone

(619) 426-9600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peter P Rullan, M.D.

  • Procedural Dermatology Physician
  • Chula Vista, CA
  • NPI 1114963170
  Medicare reassignment Care Compare group NPD Authorized official
• Jacqueline McKesey

  • Dermatology Physician
  • Chula Vista, CA
  • NPI 1811422801
  Medicare reassignment Care Compare group NPD
• Jennifer Rullan, MD

  • Dermatology Physician
  • Chula Vista, CA
  • NPI 1447484811
  Medicare reassignment Care Compare group NPD
• Megan M. Brown, MD

  • Dermatology Physician
  • Tyler, TX
  • NPI 1386087617

  CA

  Medicare reassignment NPD
• Elizabeth F Schaut, PA-C

  • Physician Assistant
  • Worcester, MA
  • NPI 1629486006

  CA

  Medicare reassignment
• Maya Firsowicz, MD

  • Dermatology Physician
  • La Mesa, CA
  • NPI 1194353631
  NPD (past)
• Jennifer Trimai, PA-C

  • Physician Assistant
  • Chula Vista, CA
  • NPI 1730454091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1033289574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 LANDIS AVE",
            "address_2": "THIRD FLOOR",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102650",
            "telephone_number": "619-426-9600",
            "fax_number": "619-426-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 LANDIS AVE",
            "address_2": "THIRD FLOOR",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102650",
            "telephone_number": "619-426-9600",
            "fax_number": "619-426-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY SKIN & CANCER MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "RULLAN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "619-426-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G42243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73699Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Bay Mediquipment Inc
• South Bay OBGYN
• South Bay Pediatric Dental Group
• South Bay Physical Medicine, Inc.
• South Bay Serenity and Guidance
• South Bay Surgical Associates Medical Group Inc.
• Southbay Cardiovascular Medical Center, Inc
• Southbay Neurological Med GR
• Southern California Anesthesia Services, LLC
• Southern California Fatty Liver Center Inc

• Procedural Dermatology Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.