Spade Skin Care Medical Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A100364 Issued in CA

Legal business name

SPADE SKIN CARE MEDICAL INC

Practice address

1611 S Catalina Ave Ste L70
Redondo Beach, CA 90277-5296

Phone

(310) 316-1954

Fax

(310) 504-1739

NPI assigned

Mar 8, 2017

Organization subpart

No

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

Authorized official

Name

Dr. John O'Neil Simmonds, M.D.NPI 1801195912

Title

President

Phone

(310) 316-1954

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• John Oneil Simmonds, M.D

  • Orthopaedic Surgery Physician
  • Los Angeles, CA
  • NPI 1801195912
  NPD (past) Authorized official
• Carley Cassity, NP

  • Nurse Practitioner
  • Los Angeles, CA
  • NPI 1588162556
  NPD (past)
• Nishita Rasik Patolia, DNP, FNP-C

  • Nurse Practitioner
  • Redondo Beach, CA
  • NPI 1912511403
  NPD (past)

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1790225829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S CATALINA AVE STE L70",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775296",
            "telephone_number": "310-316-1954",
            "fax_number": "310-504-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S CATALINA AVE STE L70",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775296",
            "telephone_number": "310-316-1954",
            "fax_number": "310-504-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPADE SKIN CARE MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-08",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "SIMMONDS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "O'NEIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-316-1954",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A100364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anna Southam, PT
• Southbay Galleria Optometric
• Speechcom Children'S Speech Therapy Center, Inc.
• Speechcom Incorporated
• Sophia Rose Spengler, PHYSICIAN ASSISTANT
• Stacy L Reger PH D a Psychological Corporation
• Fred C Stalley, D.D.S.

• Dermatology Physician in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; 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.