Organization
SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC.
Active
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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