Dermdocs

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

DERMDOCS

Doing business as

Portrait Health

Practice address

1022 N El Camino Real # 134
Encinitas, CA 92024-1320

Phone

(858) 293-1152

Fax

(858) 780-5287

NPI assigned

Aug 5, 2022

Last updated

Aug 18, 2022By 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. Patrick Blake, MD

Title

Chief Medical Officer

Phone

(858) 375-3653

Specialties & licenses 1

Addresses

Other names 1

• Portrait Health Doing business as

Locations

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

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1972230217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12707 HIGH BLUFF DR STE 350",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303003",
            "telephone_number": "858-293-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 N EL CAMINO REAL # 134",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920241320",
            "telephone_number": "858-293-1152",
            "fax_number": "858-780-5287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMDOCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "858-375-3653",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portrait Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Philip Demoss, DPT
• Farhad Dena, D.D.S.
• Susan Drake Dennett, L. AC.
• Stephen Michael Dent, MD
• Dental Specialty Associates
• Michelle Dern, M.D
• Desha Inc
• Leticia Desimone, MASSAGE THERAPIST
• William J Dess, PHD
• Lynda Gayle Detweiler-Newcomb, SLP6849

• Medical Specialty Clinic/Center in Encinitas, CA
• Providers in Encinitas, 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 Aug 18, 2022; 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.