Organization Active NPI

Santa Monica Dermatology Group

  • Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1356870067
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SANTA MONICA DERMATOLOGY GROUP
Practice address
2001 Santa Monica Blvd Ste 990W
Santa Monica, CA 90404
Phone
(310) 829-4484
NPI assigned
Jun 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Authorized official

Name
Maria Mendoza
Title
Office Manager
Phone
(310) 829-4484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2001 Santa Monica Blvd Ste 990W
Santa Monica, CA 90404

Mailing address

2001 Santa Monica Blvd Ste 990W
Santa Monica, CA 90404-2155
Phone (310) 829-4484

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170815001055 CA Part B Supplier - Clinic/Group Practice 8123390986 Receives reassigned benefits from 4 practitioners
Practice locations: Santa Monica, CA

National Provider Directory

National Provider Directory

Locations

2001 Santa Monica Blvd
Ste 990W
Santa Monica, CA 90404
Phone (310) 829-4481

2001 Santa Monica Blvd
Ste 990
Santa Monica, CA 90404

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e1A5O_wfjp6bxazsKQMUgQtMMK_UwF9x/

Practitioners & affiliated clinicians

Practitioners 6

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": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1356870067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD STE 990W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042155",
            "telephone_number": "310-829-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SANTA MONICA BLVD STE 990W",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-829-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MONICA DERMATOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "310-829-4484"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; 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.