Organization
CORONA DERMATOLOGY CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOY FORTICH (BILLING MANAGER)
(909) 860-7600
Entity
Organization
Contact information
Practice address
1810 FULLERTON AVE, STE 101, CORONA, CA 92881-3103
(951) 734-7900
(909) 860-2757
Mailing address
PO BOX 15807, BEVERLY HILLS, CA 90209-1807
(909) 860-7600
(909) 860-2757
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G044761
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G044761
CA
207ND0900X
Dermatopathology Physician
G044761
CA
207NP0225X
Pediatric Dermatology Physician
G044761
CA
207NS0135X
Procedural Dermatology Physician
G044761
CA
Other
Enumeration date
08/20/2006
Last updated
01/13/2010
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