Dermclub X Madison Shreeve Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

DERMCLUB X MADISON SHREEVE INC

Practice address

747 Dover Dr Ste B
Newport Beach, CA 92663-6927

Phone

(979) 706-2872

NPI assigned

May 1, 2024

Organization subpart

No

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

Authorized official

Name

Madison Shreeve

Title

Ceo

Phone

(949) 706-2872

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1285481986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 DOVER DR STE B",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926636927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 DOVER DR STE B",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926636927",
            "telephone_number": "979-706-2872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMCLUB X MADISON SHREEVE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "SHREEVE",
        "authorized_official_first_name": "MADISON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-706-2872"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Depke, B.A., OBT, NCBTMB
• Glen Depke, BS, ND
• Paul T Depompo, PSY.D.
• Paul Deridder, MD
• Dermatology & Laser Clinic, Inc.
• Michael Derose, COTA/L
• Shaunak Subhash Desai, M.D.
• Tanya Sarkisian Desloover
• Melissa Louise Desouza, MD
• Danielle Desrosier

• Nurse Practitioner in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.