Organization
BEVERLY DERMATOLOGY AND LASER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROLAND BEVERLY MD (OWNER)
(909) 335-8638
Entity
Organization
Contact information
Practice address
24541 PACIFIC PARK DR, SUITE 103, ALISO VIEJO, CA 92656-3065
(909) 335-8638
Mailing address
PO BOX 51197, DEPT 201, LOS ANGELES, CA 90051-5497
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
12/29/2006
Last updated
08/22/2020
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