NPIMap

Organization Active NPI

Magnolia Dermatology Inc

  • Dermatology Physician
  • Corona, CA
National Provider Identifier
1972990653
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A76333 Issued in CA
Legal business name
MAGNOLIA DERMATOLOGY INC
Practice address
770 Magnolia Ave
Suite 2G
Corona, CA 92879-3120
Phone
(951) 734-6500
Fax
(951) 734-6555
NPI assigned
Apr 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Authorized official

Name
Dr. Babak Roshdieh, M.D.
Title
Owner
Phone
(951) 734-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X A76333 CA Primary

Addresses

Primary practice location

770 Magnolia Ave
Suite 2G
Corona, CA 92879-3120

Mailing address

770 Magnolia Ave
Suite 2G
Corona, CA 92879-3120
Phone (951) 734-6500

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1972990653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 MAGNOLIA AVE",
            "address_2": "SUITE 2G",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793120",
            "telephone_number": "951-734-6500",
            "fax_number": "951-734-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 MAGNOLIA AVE",
            "address_2": "SUITE 2G",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793120",
            "telephone_number": "951-734-6500",
            "fax_number": "951-734-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "ROSHDIEH",
        "authorized_official_first_name": "BABAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-734-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A76333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.