NPIMap

Organization Active NPI

Dermatology Specialists, Inc

  • Dermatology Physician
  • Menifee, CA
National Provider Identifier
1962891705
Registry record updated Jan 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY SPECIALISTS, INC
Practice address
29826 Haun Rd
#308
Menifee, CA 92586-6546
Phone
(951) 304-7546
NPI assigned
Jan 16, 2015
Last updated
Jan 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2015

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

Authorized official

Name
Jane Lisk
Title
Administrator
Phone
(760) 757-7546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

29826 Haun Rd
#308
Menifee, CA 92586-6546

Mailing address

3629 Vista Way
Oceanside, CA 92056-4522
Phone (760) 757-7546

National Provider Directory

National Provider Directory
Tax ID family
Dermatology Specialists Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3629 Vista Way
Oceanside, CA 92056
Phone (760) 757-7546

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1962891705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3629 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564522",
            "telephone_number": "760-757-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29826 HAUN RD",
            "address_2": "#308",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925866546",
            "telephone_number": "951-304-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "last_updated": "2015-01-16",
        "status": "A",
        "authorized_official_last_name": "LISK",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "760-757-7546"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menifee, CA

Sources for this page

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