Organization
WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION
Active
Organization
WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION
Active
Other names
Beach Cities Dematology Med Center
Organization subpart
No
Provider details
NPI number
Authorized official
NEAL M AMMAR M.D (CEO)
(310) 798-1515
Entity
Organization
Contact information
Practice address
520 N PROSPECT AVE, STE 302, REDONDO BEACH, CA 90277-3041
(310) 798-1515
(310) 798-3131
Mailing address
520 N PROSPECT AVE, STE 302, REDONDO BEACH, CA 90277-3041
(310) 798-1515
(310) 798-3131
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G650830
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G650830
MEDICARE NORTHERN CA ID
CA
05
—
00G650830
—
CA
Enumeration date
11/13/2006
Last updated
03/24/2022
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