Organization
BERNARDO DERMATOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH ANN LARSON MD (PRESIDENT)
(858) 451-3311
Entity
Organization
Contact information
Practice address
15525 POMERADO RD, SUITE A2, POWAY, CA 92064-2435
(858) 451-3311
(858) 451-1142
Mailing address
15525 POMERADO RD, SUITE A2, POWAY, CA 92064-2435
(858) 451-3311
(858) 451-1142
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G41388
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G41388
CA
207ND0900X
Dermatopathology Physician
G49647
CA
Other
Enumeration date
09/08/2006
Last updated
11/06/2007
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