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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