Individual
JAY APPLEBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17601 17TH ST STE 110, TUSTIN, CA 92780-1946
(714) 790-0005
(714) 699-2444
Mailing address
17601 17TH ST STE 110, TUSTIN, CA 92780-1946
(714) 790-0005
(714) 699-2444
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
G054219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G542191
—
CA
01
—
05D0896423
CLIA
CA
01
—
G54219
MEDICAL LICENSE
CA
Enumeration date
07/10/2006
Last updated
02/27/2020
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