NPIMap

Organization Active NPI

Advanced Dermatology & Cosmetics Laser Care a Medical Corporation

  • Specialist
  • Valencia, CA
National Provider Identifier
1912026097
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ADVANCED DERMATOLOGY & COSMETICS LASER CARE A MEDICAL CORPORATION
Practice address
28212 Kelly Johnson Pkwy
Suite 245
Valencia, CA 91355-5084
Phone
(661) 254-3686
Fax
(661) 254-5671
NPI assigned
Mar 28, 2007
Last updated
Dec 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Authorized official

Name
Dr. Bernard I Raskin, MDNPI 1013941962
Title
Medical Director
Phone
(661) 254-3686

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

28212 Kelly Johnson Pkwy
Suite 245
Valencia, CA 91355-5084

Mailing address

28212 Kelly Johnson Pkwy
Suite 245
Valencia, CA 91355-5084
Phone (661) 254-3686

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081117000122 CA Part B Supplier - Clinic/Group Practice 5395659460 Receives reassigned benefits from 14 practitioners
Practice locations: Valencia, CA; Porter Ranch, CA; Palmdale, CA; Bakersfield, CA

National Provider Directory

National Provider Directory

Locations

19709 Rinaldi St
Porter Ranch, CA 91326
Phone (661) 254-3686

23861 McBean Pkwy
Ste E21
Valencia, CA 91355
Phone (626) 900-8875

28212 Kelly Johnson Pkwy
Ste 245
Valencia, CA 91355
Phone (661) 254-3686

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1912026097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY",
            "address_2": "SUITE 245",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555084",
            "telephone_number": "661-254-3686",
            "fax_number": "661-254-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY",
            "address_2": "SUITE 245",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555084",
            "telephone_number": "661-254-3686",
            "fax_number": "661-254-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY & COSMETICS LASER CARE A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "RASKIN",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "661-254-3686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.