Organization
SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED F SHAHAN M.D., PHARM.D. (PRESIDENT)
(619) 287-1882
Entity
Organization
Contact information
Practice address
6367 ALVARADO CT, SUITE 107, SAN DIEGO, CA 92120-4904
(619) 287-1882
(619) 287-4121
Mailing address
6367 ALVARADO CT, SUITE 107, SAN DIEGO, CA 92120-4904
(619) 287-1882
(619) 287-4121
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G83901
CA
Other
Enumeration date
10/25/2006
Last updated
12/26/2012
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