Glendora Dermatologic and Cosmetic Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GLENDORA DERMATOLOGIC AND COSMETIC SURGERY CENTER

Practice address

412 W. Carroll Ave
Suite 208
Glendora, CA 91741-4280

Phone

(626) 335-1606

Fax

(626) 963-0575

NPI assigned

Aug 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Daniel E Gormley, MD

Title

Owner /President

Phone

(626) 335-1606

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285804800000",
    "number": "1043323801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 W CARROLL AVE",
            "address_2": "SUITE 208",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414240",
            "telephone_number": "626-335-1606",
            "fax_number": "626-963-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W. CARROLL AVE",
            "address_2": "SUITE 208",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414280",
            "telephone_number": "626-335-1606",
            "fax_number": "626-963-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDORA DERMATOLOGIC AND COSMETIC SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2010-09-30",
        "status": "A",
        "authorized_official_last_name": "GORMLEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER /PRESIDENT",
        "authorized_official_telephone_number": "626-335-1606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN (MEDICARE LEGACY #)",
            "identifier": "S551093",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Jane Gladney
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• Glendora Ca Endoscopy ASC LP
• Glendora Chiropractic Center
• Glendora Family Counseling, a Professional Corporation
• Glendora Family Therapy, Inc
• Glendora Grand, Inc.
• Glendora Medical Associates
• Glendora Optometry Apc

• Ambulatory Surgical Clinic/Center in Glendora, CA
• Providers in Glendora, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.