Organization
PACIFIC SHORES DERMATOLOGY & SKIN CANCER INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA SANDOVAL DO (OWNER)
(760) 217-1457
Entity
Organization
Contact information
Practice address
860 OAK PARK BLVD STE 101, ARROYO GRANDE, CA 93420-1800
(805) 202-8245
(805) 202-8117
Mailing address
PO BOX 2505, PISMO BEACH, CA 93448-2505
(805) 202-8245
(805) 202-8117
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Enumeration date
09/24/2024
Last updated
10/16/2024
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