Organization
NOVATO DERMATOLOGY ASSOCIATES A MEDICAL CORPORATION
Active
Organization
NOVATO DERMATOLOGY ASSOCIATES A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM S FREDERICKSON MD (OWNER)
(415) 892-0754
Entity
Organization
Contact information
Practice address
867 DIABLO AVE, NOVATO, CA 94947-4007
(415) 892-0754
(415) 897-3204
Mailing address
867 DIABLO AVE, NOVATO, CA 94947-4007
(415) 892-0754
(415) 897-3204
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G79619
CA
Other
Enumeration date
01/23/2007
Last updated
11/08/2018
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