Pacific Dermatology Institute

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A79221 Issued in CA

Legal business name

PACIFIC DERMATOLOGY INSTITUTE

Practice address

240 Newport Center Dr
Suite 105
Newport Beach, CA 92660-7512

Phone

(946) 644-2450

Fax

(946) 644-2451

NPI assigned

May 8, 2015

Last updated

May 8, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Bottomley

Title

Practice Administrator

Phone

(909) 362-2966

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Bradley Pierce Mudge, MD

  • Plastic Surgery Physician
  • Newport Beach, CA
  • NPI 1891764700

  Dermatology

  NPD

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1922486117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 NEWPORT CENTER DR",
            "address_2": "SUITE 105",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607512",
            "telephone_number": "946-644-2450",
            "fax_number": "946-644-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 NEWPORT CENTER DR",
            "address_2": "SUITE 105",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607512",
            "telephone_number": "946-644-2450",
            "fax_number": "946-644-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC DERMATOLOGY INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A",
        "authorized_official_last_name": "BOTTOMLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "909-362-2966",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A79221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pacific Coast Medical Group Inc
• Pacific Coast Medicine, a Professional Corporation
• Pacific Coast Physical Therapy
• Pacific Coast Therapy and Family Counseling Inc.
• Pacific Cosmetic and Facelift Center Inc.
• Pacific Hospitalist Associates a Medical Corporation (Pacific Hospitalist Associates)
• Pacific Hospitalist Associates a Medical Corporation
• Pacific Innovative Healthcare
• Pacific Interventionalists, Inc.
• Pacific Medical and Wellness Group Inc

• Dermatology Physician in Newport Beach, CA
• Providers in Newport 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 May 8, 2015; 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.