Organization
DIAKONIAMED
Active
Other names
Exceptional Dermatology Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID SIRE MD (MEDICAL DIRECTOR)
(714) 882-5525
Entity
Organization
Contact information
Practice address
2720 N HARBOR BLVD STE 205, FULLERTON, CA 92835-2609
(718) 882-5525
(714) 882-5078
Mailing address
301 W BASTANCHURY RD STE 140, FULLERTON, CA 92835-3427
(714) 882-5525
(714) 882-5078
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A22972
MEDICAL LIC
CA
Enumeration date
05/14/2018
Last updated
07/16/2019
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