Organization
LACA DERMATOLOGY, INC
Active
Other names
LACA DERMATOLOGY INC, LACA DERMATOLOGY,INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN VINE MD (MD)
(818) 789-6296
Entity
Organization
Contact information
Practice address
4955 VAN NUYS BLVD STE 516, SHERMAN OAKS, CA 91403-1832
(818) 789-6296
(818) 789-0374
Mailing address
1920 HILLHURST AVE #158, LOS ANGELES, CA 90027-3352
(818) 789-6296
(818) 789-0374
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
C53733
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487636858
INDIVIDUAL NPI
NY
Enumeration date
02/15/2018
Last updated
03/25/2019
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