Organization
DERMATOLOGY & LASER CLINIC, INC.
Active
Organization
DERMATOLOGY & LASER CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA HITE M.D. (CEO)
(949) 631-0300
Entity
Organization
Contact information
Practice address
401 OLD NEWPORT BLVD, SUITE 102, NEWPORT BEACH, CA 92663-4269
(949) 631-0300
(949) 631-0302
Mailing address
401 OLD NEWPORT BLVD, SUITE 102, NEWPORT BEACH, CA 92663-4269
(949) 631-0300
(949) 631-0302
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A69586
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A69586
CA
207NS0135X
Procedural Dermatology Physician
A69586
CA
Other
Enumeration date
02/01/2007
Last updated
01/19/2012
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