Organization
LACA DERMATOLOGY, INC
Active
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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