Organization Active NPI

Dermatology Institute & Skin Care Center, Inc.

  • Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1164532339
Registry record updated Feb 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A53239 Issued in CA
Legal business name
DERMATOLOGY INSTITUTE & SKIN CARE CENTER, INC.
Practice address
2001 Santa Monica Blvd
#1160W
Santa Monica, CA 90404-2102
Phone
(310) 829-4104
Fax
(310) 829-4150
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2017

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

Authorized official

Name
Ms. Veronica Partida
Title
Practice Manager
Phone
(310) 829-4104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X A53239 CA Primary

Addresses

Primary practice location

2001 Santa Monica Blvd
#1160W
Santa Monica, CA 90404-2102

Mailing address

2001 Santa Monica Blvd
#1160W
Santa Monica, CA 90404-2102
Phone (310) 829-4104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051114001246 CA Part B Supplier - Clinic/Group Practice 6901825421 Receives reassigned benefits from 3 practitioners
Practice locations: Santa Monica, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1038446Dermatology Institute2001 Santa Monica Blvd, Ste 1160W, Santa Monica, CA 90404ComplianceOct 3, 2027

National Provider Directory

National Provider Directory

Locations

2001 Santa Monica Blvd
Ste 116
Santa Monica, CA 90404

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485993600000",
    "number": "1164532339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD",
            "address_2": "#1160W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042102",
            "telephone_number": "310-829-4104",
            "fax_number": "310-829-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD",
            "address_2": "#1160W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042102",
            "telephone_number": "310-829-4104",
            "fax_number": "310-829-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY INSTITUTE & SKIN CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-02-02",
        "status": "A",
        "authorized_official_last_name": "PARTIDA",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "310-829-4104",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A53239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; 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.