Organization
EL SEGUNDO DERMATOLOGY, INC.
Active
Other names
Gardena Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA FELLMAN (PRACTICE MANAGER)
(310) 906-2788
Entity
Organization
Contact information
Practice address
713 N DOUGLAS ST., EL SEGUNDO, CA 90245
(310) 906-2788
(310) 906-2786
Mailing address
713 N. DOUGLAS ST., EL SEGUNDO, CA 90245
(310) 906-2788
(310) 906-2786
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100120719
—
CA
Enumeration date
07/17/2015
Last updated
08/11/2022
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