Individual
DR. TANYA KORMEILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2811 WILSHIRE BLVD STE 640, SANTA MONICA, CA 90403-4823
(310) 526-8301
Mailing address
2811 WILSHIRE BLVD STE 640, SANTA MONICA, CA 90403-4823
(310) 526-8301
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A83828
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A83838
CA
207ND0900X
Dermatopathology Physician
A83828
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
A83828
CA
207NP0225X
Pediatric Dermatology Physician
A83828
CA
207NS0135X
Procedural Dermatology Physician
A83828
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WA83828A
MEDICARE PIN
—
Enumeration date
04/26/2007
Last updated
08/02/2018
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