Organization
RAINCROSS MEDICAL CENTER OF DERMATOLOGY AND COSMETIC SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN QUAN NGUYEN MD (MEDICAL DIRECTOR)
(951) 682-9293
Entity
Organization
Contact information
Practice address
4336 MARKET ST, RIVERSIDE, CA 92501-3518
(951) 682-9293
(951) 682-9299
Mailing address
4336 MARKET ST, RIVERSIDE, CA 92501-3518
(951) 682-9293
(951) 682-9299
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
G77748
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00017530
RAILROAD MEDICARE
CA
Enumeration date
05/05/2006
Last updated
08/01/2013
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