Organization
CENTRAL VALLEY DERMATOLOGY MEDICAL GROUP, A PROFESSIONAL CORPORATION
Active
Other names
Central Valley Dermatology Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
BASIL M HANTASH MD, PHD (PRESIDENT)
(408) 204-8946
Entity
Organization
Contact information
Practice address
3800 GEER RD STE 200, TURLOCK, CA 95382-1146
(209) 250-1442
(209) 668-4992
Mailing address
3800 GEER RD STE 200, TURLOCK, CA 95382-1146
(209) 250-1442
(209) 668-4992
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA7300
RAILROAD MEDICARE GROUP#
—
01
—
ZZZ20312Z
MEDICARE GROUP ID#
—
Enumeration date
09/13/2006
Last updated
05/12/2020
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