Organization
COAST DERMATOLOGY MEDICAL ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK KEVIN HOROWITZ D.O. (PRESIDENT)
(310) 373-2636
Entity
Organization
Contact information
Practice address
23550 HAWTHORNE BLVD, #200, TORRANCE, CA 90505-4722
(310) 373-2636
(310) 373-2633
Mailing address
23550 HAWTHORNE BLVD, STE 200, TORRANCE, CA 90505-4722
(310) 534-9131
(310) 534-9132
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
CA
207ND0101X
MOHS-Micrographic Surgery Physician
—
CA
207ND0900X
Dermatopathology Physician
—
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
CA
207NP0225X
Pediatric Dermatology Physician
—
CA
207NS0135X
Procedural Dermatology Physician
—
CA
Other
Enumeration date
05/05/2011
Last updated
09/04/2012
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