Dermesurge Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMESURGE INC

Practice address

1111 Grand Ave Ste K
Diamond Bar, CA 91765-4172

Phone

(909) 860-4254

NPI assigned

May 12, 2021

Last updated

Sep 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sam Abaza, MDNPI 1831148501

Title

Owner

Phone

(818) 726-8722

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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.

• Sam Abaza, M.D.

  • Dermatology Physician
  • Diamond Bar, CA
  • NPI 1831148501
  Medicare reassignment NPD Authorized official
• Felipe De Jesus Coronado, PA-C

  • Physician Assistant
  • Diamond Bar, CA
  • NPI 1508920059
  Medicare reassignment

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694304000000",
    "number": "1538743752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 GRAND AVE STE K",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654172",
            "telephone_number": "190-986-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GRAND AVE STE K",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654172",
            "telephone_number": "909-860-4254"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 S Harbor Blvd",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "92805",
            "country_code": "US",
            "telephone_number": "909-860-4254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMESURGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2023-09-10",
        "certification_date": "2023-09-10",
        "status": "A",
        "authorized_official_last_name": "ABAZA",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-726-8722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Davis
• Del Sol Pace LLC
• Tricia Dela Cruz, LMFT
• Silvia Delgado, R.D., C.D.E.
• Dermesurge Inc
• Aarohi Hemang Desai, PHARMD
• Sneha Jitendra Desai
• Desiree Depace a Licensed Marriage & Family Therapist Prof Corp (A Therapist Near Me)
• Diamond Bar Cardiovascular Medical Group Inc
• Diamond Bar Dental Group

• Dermatology Physician in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2023; 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.