Organization
TELEGRAPH DERMATOLOGY MEDICAL GROUP INC
Active
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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