Organization
CRYSTAL COVE DERMATOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARGUERITE J CRITELLI M.D. (OWNER)
(949) 640-9633
Entity
Organization
Contact information
Practice address
1441 AVOCADO AVE, SUITE 602, NEWPORT BEACH, CA 92660-7721
(949) 640-9633
(949) 640-9677
Mailing address
1441 AVOCADO AVE, SUITE 602, NEWPORT BEACH, CA 92660-7721
(949) 640-9633
(949) 640-9677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G076233
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G76233
STATE LICENSE
CA
Enumeration date
05/22/2007
Last updated
06/13/2008
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