Organization
SOUTH COAST DERMATOLOGY INSTITUTE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCE F AFSAHI M.D. (PRESIDENT)
(714) 508-0754
Entity
Organization
Contact information
Practice address
2552 WALNUT AVE, SUITE 120, TUSTIN, CA 92780-6935
(714) 508-0754
(714) 508-5754
Mailing address
2552 WALNUT AVE, SUITE 120, TUSTIN, CA 92780-6935
(714) 508-0754
(714) 508-5754
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700888690
NPI TYPE I IND.DR. AFSAHI
CA
Enumeration date
03/12/2007
Last updated
01/05/2011
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