NPIMap

Organization Active NPI

Dermatology & Laser Center of San Diego

  • Dermatology Physician
  • Chula Vista, CA
National Provider Identifier
1457396178
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY & LASER CENTER OF SAN DIEGO
Practice address
344 F St Ste 200
Chula Vista, CA 91910-2646
Phone
(619) 476-1200
Fax
(619) 420-7849
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Miss Sara Rosales
Title
Insurance Specialist
Phone
(619) 476-1200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A69750 CA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A78399 CA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X C36597 CA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A94658 CA
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

344 F St Ste 200
Chula Vista, CA 91910-2646

Mailing address

344 F St Ste 200
Chula Vista, CA 91910-2646
Phone (619) 476-1200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060807000479 CA Part B Supplier - Clinic/Group Practice 5395748669 Receives reassigned benefits from 15 practitioners
Practice locations: San Diego, CA; Chula Vista, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1007383Dermatology and Laser Center of San Diego344 F St, Ste 200, Chula Vista, CA 91910ComplianceOct 22, 2027

National Provider Directory

National Provider Directory

Locations

319 F St
Ste 102
Chula Vista, CA 91910
Phone (619) 476-1200

344 F St
Chula Vista, CA 91910

4060 4th Ave
Ste 209
San Diego, CA 92103
Phone (619) 298-9535

6386 Alvarado Ct
Ste 205
San Diego, CA 92120
Phone (619) 229-0361

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1457396178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 F ST STE 200",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102646",
            "telephone_number": "619-476-1200",
            "fax_number": "619-420-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 F ST STE 200",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102646",
            "telephone_number": "619-476-1200",
            "fax_number": "619-420-7849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & LASER CENTER OF SAN DIEGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "ROSALES",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "619-476-1200",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69750",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A78399",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C36597",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A94658",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.