Dermatology Specialists Ins
Organization Active NPI Dermatology Physician · Fallbrook, CA
NPI 1457541260 · NPPES record last updated Nov 26, 2008
Key facts
- NPI
- 1457541260
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- DERMATOLOGY SPECIALISTS INS
- Practice address
- 1309 S Mission Rd # a
Fallbrook, CA 92028-4007 - Phone
- (760) 728-7546
- Fax
- (760) 723-6208
- NPI assigned
- Jul 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Jane Lisk
- Title
- Administrator
- Phone
- (760) 757-7546
Corporate family (same tax ID) 6
Practitioners 3
-
Andrew Louis Ross, M.D.
-
Joseph A Samady, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0567097 | Dermatology Specialists, Inc | Provider-performed microscopy | Aug 31, 2026 |
National Provider Directory
- Tax ID family
- Dermatology Specialists Inc
Locations
3629 Vista Way
Oceanside, CA 92056
Phone (760) 757-7546
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | CA | Yes |
Addresses
Primary practice location
1309 S Mission Rd # a
Fallbrook, CA 92028-4007
Mailing address
3629 Vista Way
Oceanside, CA 92056-4522
Phone (760) 828-9200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881631711 | Other | CA | GROUP NPI |
| GR0029462 | Medicaid | CA |
Other providers in Fallbrook, CA
- Gabriel Davis
- Francisco De Los Santos Jr.
- Zoe De Venture
- Natasha Defendis
- Amanda M Del Re
- Paul Des Rosiers
- Leon Frank Desimone
- Rosario Joseph Desimone
- Todd Andrew Dickman
- Celeste Marie Dimilla
All providers in Fallbrook, CA · Dermatology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.