William F Resh MD, Skin & Skin Cancer Medical Group of San Diego, Inc.
Organization Active NPI Specialist · National City, CA
NPI 1790973162 · NPPES record last updated Jun 9, 2022
Key facts
- NPI
- 1790973162
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- WILLIAM F RESH MD, SKIN & SKIN CANCER MEDICAL GROUP OF SAN DIEGO, INC.
- Practice address
- 655 Euclid Ave Ste 304
National City, CA 91950-2974 - Phone
- (619) 267-8303
- Fax
- (619) 267-4835
- NPI assigned
- Oct 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Brooke Resh Sateesh, M.D.
- Title
- Owner
- Phone
- (619) 267-8303
Other NPIs on the same Medicare enrollment 3
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 3
Practitioners 18
-
Victoria Regina Barrio, M.D.
-
Nicholas Joseph Celano, M.D.
-
Jennifer Yeh Chiang, M.D.
-
Justin Stanley Gordon, M.D.
-
Shinko Lin, M.D.
-
Abhilasha Tyagi, MD
-
Nathan S. Uebelhoer, D.O.
-
David Isaac Weiss, MD, PHD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2115868 | San Diego Family Dermatology | Compliance | Apr 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040430000629 | CA | Part B Supplier - Clinic/Group Practice | 4082601935 |
Receives reassigned benefits from 18 practitioners 3 other NPIs on this enrollment Practice locations: Poway, CA; San Diego, CA; National City, CA; El Cajon, CA |
National Provider Directory
- Tax ID family
- William F Resh MD Skin S
Locations
655 Euclid Ave
Ste 401
National City, CA 91950
Phone (619) 267-8303
15725 Pomerado Rd
Ste 102
Poway, CA 92064
Phone (619) 267-8303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
655 Euclid Ave Ste 304
National City, CA 91950-2974
Mailing address
655 Euclid Ave Ste 304
National City, CA 91950-2974
Phone (619) 267-8303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C346610 | Medicaid | CA |
Other names
- San Diego Family Dermatology
Other providers in National City, CA
- Western Dental Services, Inc.
- Western Dental Services, Inc.
- Western Educational Corporation
- Marjorie B Wilkins
- Raquel J Willey
- William T Chapman MD Inc
- Maria Helena Williamson
- Constance Berthea Wilson
- Jack Anthony Wilson
- Windsor Care Center National City, Inc
All providers in National City, CA · Specialist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.