San Diego Skin, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A83432 Issued in CA

Legal business name

SAN DIEGO SKIN, INC.

Practice address

4150 Regents Park Row
Suite 300
La Jolla, CA 92037-9124

Phone

(858) 909-9000

Fax

(858) 909-9009

NPI assigned

Dec 2, 2009

Organization subpart

No

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

Authorized official

Name

M. Mark Mofid, M.D.

Title

President

Phone

(858) 909-9000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

San Diego Skin IncCCN 05C0001936

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Mehrdad Mark Mofid, M.D.

  • Plastic Surgery Physician
  • La Jolla, CA
  • NPI 1225244155
  NPD

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1972831998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 REGENTS PARK ROW",
            "address_2": "SUITE 300",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379124",
            "telephone_number": "858-909-9000",
            "fax_number": "858-909-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 REGENTS PARK ROW",
            "address_2": "SUITE 300",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379124",
            "telephone_number": "858-909-9000",
            "fax_number": "858-909-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO SKIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-02",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "MOFID",
        "authorized_official_first_name": "M.",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-909-9000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "A83432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Diego Optical
• San Diego Pacific Oncology and Hematology Associates Inc
• San Diego Pain Medicine
• San Diego Pain Medicine
• San Diego Rehab Specialists Inc
• San Diego Sleep Medicine Inc
• San Diego SNF Hospitalists
• San Diego Span
• San Diego Surgical Assistants, Inc
• San Diego VA Healthcare System

• Ambulatory Surgical Clinic/Center in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.