Organization
RADIANT DERMATOLOGY, INC.
Active
Organization
RADIANT DERMATOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNA NATALIE QUELLER MD (MEDICAL DIRECTOR)
(424) 208-3251
Entity
Organization
Contact information
Practice address
421 N RODEO DR STE T7, BEVERLY HILLS, CA 90210-4531
(310) 274-5372
Mailing address
10501 EASTBORNE AVE, LOS ANGELES, CA 90024-6001
(424) 208-3251
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A127029
CA
Other
Enumeration date
12/09/2017
Last updated
12/09/2017
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