Telegraph Dermatology Medical Group Inc

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

TELEGRAPH DERMATOLOGY MEDICAL GROUP INC

Practice address

8337 Telegraph Rd
Suite 210
Pico Rivera, CA 90660-4909

Phone

(563) 806-1321

Fax

(562) 806-0801

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Fernando Basco Canon, M.D.

Title

President

Phone

(562) 806-1321

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1245369941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8337 TELEGRAPH RD",
            "address_2": "SUITE 210",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604909",
            "telephone_number": "563-806-1321",
            "fax_number": "562-806-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8337 TELEGRAPH RD",
            "address_2": "SUITE 210",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604909",
            "telephone_number": "563-806-1321",
            "fax_number": "562-806-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELEGRAPH DERMATOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "CANON",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_middle_name": "BASCO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-806-1321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0552524",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Pico Rivera, CA
• Providers in Pico Rivera, 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 Apr 18, 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.