Organization
DERMATOLOGY WEST, LLC
Active
Organization
DERMATOLOGY WEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE LOREN WAGAMON MD (OWNER)
(440) 858-3176
Entity
Organization
Contact information
Practice address
26410 CENTER RIDGE RD, WESTLAKE, OH 44145-4067
(440) 858-3176
Mailing address
1445 CASTRO ST, SAN FRANCISCO, CA 94114-3717
(440) 858-3176
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780758003
PERSONAL NPI
CA
Enumeration date
05/22/2007
Last updated
08/22/2020
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