NPIMap

Organization Active NPI

Beverly Dermatology and Laser Center

  • Dermatology Physician
  • Aliso Viejo, CA
National Provider Identifier
1336205533
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BEVERLY DERMATOLOGY AND LASER CENTER
Practice address
24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065
Phone
(909) 335-8638
NPI assigned
Dec 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Roland Beverly, MDNPI 1083687776
Title
Owner
Phone
(909) 335-8638

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065

Mailing address

PO Box 51197
Dept 201
Los Angeles, CA 90051-5497

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336205533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51197",
            "address_2": "DEPT 201",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900515497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR",
            "address_2": "SUITE 103",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563065",
            "telephone_number": "909-335-8638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY DERMATOLOGY AND LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEVERLY",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-335-8638",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aliso Viejo, 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.