Boston Dermatology Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A74086 Issued in CA

Legal business name

BOSTON DERMATOLOGY CORPORATION

Practice address

262 W Badillo St
Covina, CA 91723-1906

Phone

(626) 653-2525

Fax

(626) 653-0808

NPI assigned

Sep 14, 2007

Organization subpart

No

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

Authorized official

Name

Saeed Nawaz Jaffer, M.D.NPI 1447228259

Title

President

Phone

(626) 653-2525

Specialties & licenses 5

Addresses

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Saeed Nawaz Jaffer, M.D.

  • Dermatology Physician
  • Covina, CA
  • NPI 1447228259
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1154517993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 W BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231906",
            "telephone_number": "626-653-2525",
            "fax_number": "626-653-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 W BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231906",
            "telephone_number": "626-653-2525",
            "fax_number": "626-653-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON DERMATOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "JAFFER",
        "authorized_official_first_name": "SAEED",
        "authorized_official_middle_name": "NAWAZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-653-2525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A74086",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A74086",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "A74086",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "A74086",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A74086",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Daniela Bonillas
• Shanise Lolaja Booker-Lowery
• Debbie Ann Theresa Boothe
• Isa Borbolla
• Ana Daniela Borquez Gallego
• Boston Medical and Surgical Dermatology
• Sabrina Boston
• Katie Bot
• Tara L Bourgeois
• Clemencia Bousheri

• Dermatology Physician in Covina, CA
• Providers in Covina, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.