NPIMap

Organization Active NPI

Pacific Dermatology Medical Associates, Inc

Doing business as Quail Lakes Dermatology

  • Dermatology Physician
  • Stockton, CA
National Provider Identifier
1710025994
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PACIFIC DERMATOLOGY MEDICAL ASSOCIATES, INC
Doing business as
Quail Lakes Dermatology
Practice address
4553 Quail Lakes Dr
Stockton, CA 95207-5257
Phone
(209) 951-1133
Fax
(209) 951-4708
NPI assigned
Feb 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kathryn Brigitte Rohrer, RMA
Title
Practice Administrator
Phone
(209) 951-1133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

4553 Quail Lakes Dr
Stockton, CA 95207-5257

Mailing address

4553 Quail Lakes Dr
Stockton, CA 95207-5257
Phone (209) 951-1133

Other names 1

  • QUAIL LAKES DERMATOLOGY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710025994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4553 QUAIL LAKES DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075257",
            "telephone_number": "209-951-1133",
            "fax_number": "209-951-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4553 QUAIL LAKES DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075257",
            "telephone_number": "209-951-1133",
            "fax_number": "209-951-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC DERMATOLOGY MEDICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROHRER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "BRIGITTE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "209-951-1133",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RMA"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QUAIL LAKES DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.