Vernon R. Wilson, MD a Professional Medical Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G62857 Issued in CA

Legal business name

VERNON R. WILSON, MD A PROFESSIONAL MEDICAL CORPORATION

Practice address

3445 Pacific Coast Hwy
220
Torrance, CA 90505-6658

Phone

(310) 534-9100

Fax

(310) 534-9112

NPI assigned

Jul 2, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Cassandra Starks

Title

Manager

Phone

(310) 534-9100

Specialties & licenses 1

Addresses

Other names 1

• Dermatology Treatment Center of the South Bay Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Vernon Raphael Wilson, M.D.

  • Dermatology Physician
  • Torrance, CA
  • NPI 1114983467
  Medicare reassignment NPD

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1740663160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3445 PACIFIC COAST HWY",
            "address_2": "220",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905056658",
            "telephone_number": "310-534-9100",
            "fax_number": "310-534-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3445 PACIFIC COAST HWY",
            "address_2": "220",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905056658",
            "telephone_number": "310-534-9100",
            "fax_number": "310-534-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON R. WILSON, MD A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "STARKS",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-534-9100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G62857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Treatment Center of the South Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anita Vergis, PT
• Veridian Medical Group Inc
• Verio Healthcare, Inc
• Hope Marian Vermaire, D.O.
• Vermont Healthcare Center, LLC
• Hardell Vernon
• Maryam Vernon
• Katharine Vernoy, MFT
• Vertini Holistic Medical Services Inc
• Bernice Verzosa

• Dermatology Physician in Torrance, CA
• Providers in Torrance, 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 15, 2015; 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.