NPIMap

Organization Active NPI

Dermatology Spa Med Inc

  • Dermatology Physician
  • Pismo Beach, CA
National Provider Identifier
1356094676
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY SPA MED INC
Practice address
300 James Way Ste 140
Pismo Beach, CA 93449-2874
Phone
(805) 574-1000
Fax
(805) 574-1300
NPI assigned
Jan 27, 2022
Last updated
Jan 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Authorized official

Name
Noel Cabezzas
Title
Ceo
Phone
(661) 327-4499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

300 James Way Ste 140
Pismo Beach, CA 93449-2874

Mailing address

6000 Physicians Blvd Ste 210
Bakersfield, CA 93301-1215
Phone (661) 327-4499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221117003210 CA Part B Supplier - Clinic/Group Practice 9830567189 Receives reassigned benefits from 15 practitioners
Practice locations: Pismo Beach, CA; Santa Maria, CA

National Provider Directory

National Provider Directory

Locations

300 James Way
Ste 140
Pismo Beach, CA 93449
Phone (805) 574-1000

340 James Way
Ste 140
Pismo Beach, CA 93449
Phone (805) 574-1000

120 N Miller St
Bldg Bc
Santa Maria, CA 93454
Phone (805) 739-0033

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1356094676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 PHYSICIANS BLVD STE 210",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933011215",
            "telephone_number": "661-327-4499",
            "fax_number": "661-215-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 JAMES WAY STE 140",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492874",
            "telephone_number": "805-574-1000",
            "fax_number": "805-574-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPA MED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-27",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "CABEZZAS",
        "authorized_official_first_name": "NOEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-327-4499"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pismo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.