NPIMap

Organization Active NPI

Dermatologic Plastic Surgery Clinics of Ca

  • Specialist
  • San Luis Obispo, CA
National Provider Identifier
1306960240
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C42368 Issued in CA
Legal business name
DERMATOLOGIC PLASTIC SURGERY CLINICS OF CA
Practice address
84 Santa Rosa St
San Luis Obispo, CA 93405-1812
Phone
(806) 543-5052
Fax
(805) 543-1639
NPI assigned
Mar 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Paul Stephen Collins, M.D.NPI 1437361771
Title
President
Phone
(805) 543-5052

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X C42368 CA Primary

Addresses

Primary practice location

84 Santa Rosa St
San Luis Obispo, CA 93405-1812

Mailing address

84 Santa Rosa St
San Luis Obispo, CA 93405-1812
Phone (806) 543-5052

National Provider Directory

National Provider Directory

Locations

84 Santa Rosa St
Sn Luis Obisp, CA 93405
Phone (805) 543-5052

Practitioners & affiliated clinicians

Practitioners 7

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": "1174089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306960240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051812",
            "telephone_number": "806-543-5052",
            "fax_number": "805-543-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051812",
            "telephone_number": "806-543-5052",
            "fax_number": "805-543-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGIC PLASTIC SURGERY CLINICS OF CA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-543-5052",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C42368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.