Organization
ADVANCED DERMATOLOGY SURGICAL AND MEDICAL GROUP INC.
Active
Organization
ADVANCED DERMATOLOGY SURGICAL AND MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRIC ROBERT ROSENBERG MD (OWNER)
(562) 633-6353
Entity
Organization
Contact information
Practice address
3650 E SOUTH ST, #306, LAKEWOOD, CA 90712
(562) 633-6353
(562) 633-4996
Mailing address
3650 E SOUTH ST, #306, LAKEWOOD, CA 90712
(562) 633-6353
(562) 633-4996
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4024334
AETNA
CA
01
—
G21402
GREAT-WEST
CA
05
—
GR0025890
—
CA
01
—
ZZZ12556Z
BLUE SHIELD
CA
Enumeration date
10/27/2006
Last updated
12/02/2025
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