Organization
DERMATOLOGY AND LASER GROUP OF IRVINE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINDA M GLOBERMAN MD (OWNER)
(949) 753-1001
Entity
Organization
Contact information
Practice address
16300 SAND CANYON AVE, 612, IRVINE, CA 92618-3711
(949) 753-1001
(949) 753-1115
Mailing address
16300 SAND CANYON AVE, 612, IRVINE, CA 92618-3711
(949) 753-1001
(949) 753-1115
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G34628
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BS373
MEDICARE GROUP PTAN
CA
Enumeration date
11/14/2006
Last updated
02/27/2012
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