Dermatology and Laser Group of Irvine, a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G34628 Issued in CA

Legal business name

DERMATOLOGY AND LASER GROUP OF IRVINE, A MEDICAL CORPORATION

Practice address

16300 Sand Canyon Ave
612
Irvine, CA 92618-3711

Phone

(949) 753-1001

Fax

(949) 753-1115

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Linda M Globerman, MD

Title

Owner

Phone

(949) 753-1001

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1154493369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "612",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-753-1001",
            "fax_number": "949-753-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "612",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-753-1001",
            "fax_number": "949-753-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND LASER GROUP OF IRVINE, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "GLOBERMAN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-753-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G34628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "BS373",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.