Organization
RAINCROSS MEDICAL CENTER OF DERMATOLOGY AND COSMETIC SURGERY, INC
Active
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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