Organization
DIAMOND BAR DERMATOLOGY CENTER
Active
Organization
DIAMOND BAR DERMATOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOY FORTICH (BILLING MANAGER)
(909) 860-7600
Entity
Organization
Contact information
Practice address
1200 S DIAMOND BAR BLVD, SUITE #201, DIAMOND BAR, CA 91765-2298
(909) 860-7600
(909) 860-7460
Mailing address
P.O. BOX 15807, BEVERLY HILLS, CA 90209
(909) 860-7600
(909) 860-7460
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G044761
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G044761
CA
207ND0900X
Dermatopathology Physician
G044761
CA
207NP0225X
Pediatric Dermatology Physician
G044761
CA
207NS0135X
Procedural Dermatology Physician
G044761
CA
Other
Enumeration date
07/10/2006
Last updated
12/06/2011
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