Proderm Image , a Professional Medical Corporation

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

PRODERM IMAGE , A PROFESSIONAL MEDICAL CORPORATION

Doing business as

Proderm Image

Practice address

960 S Westlake Blvd Ste 208
Westlake Village, CA 91361-3162

Phone

(805) 379-5970

Fax

(805) 379-5970

NPI assigned

Sep 16, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Noel Figueroa

Title

Office Manager

Phone

(805) 379-5970

Specialties & licenses 1

Addresses

Other names 1

• Proderm Image Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

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

• Mia De Leon, NP

  • Nurse Practitioner
  • Westlake Village, CA
  • NPI 1700119195
  Medicare reassignment NPD
• William J. Schweitzer, MD

  • Dermatology Physician
  • Woodland Hills, CA
  • NPI 1689733206
  NPD
• Thanh The Nguyen, D.O

  • Interventional Cardiology Physician
  • Glendale, CA
  • NPI 1134165194
  NPD (past)

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1811667264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 S WESTLAKE BLVD STE 208",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613162",
            "telephone_number": "805-379-5970",
            "fax_number": "805-379-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 S WESTLAKE BLVD STE 208",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613162",
            "telephone_number": "805-379-5970",
            "fax_number": "805-379-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODERM IMAGE , A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA",
        "authorized_official_first_name": "NOEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "805-379-5970",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proderm Image",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prime Health Hospice, Inc.
• Prime Lab, Inc.
• Prime Surgical Solutions Inc.
• Primecare Pharmacy LLC (PrimeCare Pharmacy)
• Lauren Prina, LMFT
• Promed Health Plus LLC
• Protocol Agency, Inc
• Prowellness Academy
• Psychological Behavioral Team Inc
• Psychotherapy Office of Jodi Frey

• Medical Specialty Clinic/Center in Westlake Village, CA
• Providers in Westlake Village, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.