NPIMap

Organization Active NPI

Marina Dermatology Associates

Doing business as Comprehensive Skin Care

  • Dermatology Physician
  • Marina del Rey, CA
National Provider Identifier
1356778476
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
18086 Issued in CA
Legal business name
MARINA DERMATOLOGY ASSOCIATES
Doing business as
Comprehensive Skin Care
Practice address
4644 Lincoln Blvd
Suite 552
Marina del Rey, CA 90292-6313
Phone
(310) 827-2653
Fax
(310) 823-1984
NPI assigned
Oct 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Authorized official

Name
Ms. Jessica Palomares
Title
Insurance Coordinator
Phone
(310) 827-2653

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 15116 CA
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 18086 CA Primary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X G45892 CA

Addresses

Primary practice location

4644 Lincoln Blvd
Suite 552
Marina del Rey, CA 90292-6313

Mailing address

4644 Lincoln Blvd
Suite 552
Marina del Rey, CA 90292-6313
Phone (310) 827-2653

Other names 1

  • Comprehensive Skin Care Doing business as

National Provider Directory

National Provider Directory

Locations

4644 Lincoln Blvd
Ste 552
Marina del Rey, CA 90292
Phone (310) 827-2653

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": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1356778476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD",
            "address_2": "SUITE 552",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926313",
            "telephone_number": "310-827-2653",
            "fax_number": "310-823-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD",
            "address_2": "SUITE 552",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926313",
            "telephone_number": "310-827-2653",
            "fax_number": "310-823-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARINA DERMATOLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "PALOMARES",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "310-827-2653",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "15116",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "18086",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G45892",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Skin Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marina del Rey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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.