Mid Valley Dermatology

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G21007 Issued in CA

Legal business name

MID VALLEY DERMATOLOGY

Practice address

4836 Van Nuys Blvd
Sherman Oaks, CA 91403-2101

Phone

(818) 907-7546

Fax

(818) 907-9506

NPI assigned

Jun 21, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Rocelyn Lucas Taylor

Title

Billing Supervisor

Phone

(818) 907-7546

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• ALLAN S WIRTZER MD Other name

Locations

Practitioners 1

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

• Ilya Reyter, M.D.

  • MOHS-Micrographic Surgery Physician
  • Sherman Oaks, CA
  • NPI 1558456517

  Procedural Dermatology

  NPD (past)

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1235335902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4836 VAN NUYS BLVD",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914032101",
            "telephone_number": "818-907-7546",
            "fax_number": "818-907-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4836 VAN NUYS BLVD",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914032101",
            "telephone_number": "818-907-7546",
            "fax_number": "818-907-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "LUCAS TAYLOR",
        "authorized_official_first_name": "ROCELYN",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "818-907-7546",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G21007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR UPIN#",
            "identifier": "A41138",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR ,CA LIC#",
            "identifier": "G21007",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLAN S. WIRTZER, MD, MEDICAL DIRECTOR NPI#",
            "identifier": "1326003161",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALLAN S WIRTZER MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael Balikyan,DDS.,Inc
• Irene Michel-Arreola
• Lidia Paola Michel, PSY. D.
• Michelle to DDS Inc
• Lindsay Rachel Mickelson Krygier, LCSW
• Mid-Valley Hospitalist Medical Group,Inc
• Mid-Valley Pulmonary Medical Group, Inc.
• Christian Middelthon, D.C.
• Ahtziri Miguel
• Mihaela Gueorguieva Mihaylova

• Procedural Dermatology Physician in Sherman Oaks, CA
• Providers in Sherman Oaks, 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 Nov 11, 2008; 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.