Organization
TELEGRAPH DERMATOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FERNANDO BASCO CANON M.D. (PRESIDENT)
(562) 806-1321
Entity
Organization
Contact information
Practice address
8337 TELEGRAPH RD, SUITE 210, PICO RIVERA, CA 90660-4909
(563) 806-1321
(562) 806-0801
Mailing address
8337 TELEGRAPH RD, SUITE 210, PICO RIVERA, CA 90660-4909
(563) 806-1321
(562) 806-0801
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0552524
CLIA
CA
Enumeration date
03/06/2007
Last updated
04/18/2012
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