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Organization
GLENDORA DERMATOLOGIC AND COSMETIC SURGERY CENTER
Active
Organization
GLENDORA DERMATOLOGIC AND COSMETIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL E GORMLEY MD (OWNER /PRESIDENT)
(626) 335-1606
Entity
Organization
Contact information
Practice address
412 W. CARROLL AVE, SUITE 208, GLENDORA, CA 91741-4280
(626) 335-1606
(626) 963-0575
Mailing address
412 W CARROLL AVE, SUITE 208, GLENDORA, CA 91741-4240
(626) 335-1606
(626) 963-0575
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
—
NULL
207NS0135X
Procedural Dermatology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/16/2006
Last updated
09/30/2010
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