Organization
DERMATOLOGY SPECIALISTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE LISK (ADMINISTRATOR)
(760) 757-7546
Entity
Organization
Contact information
Practice address
3629 VISTA WAY, OCEANSIDE, CA 92056-4522
(760) 828-9200
(760) 828-9141
Mailing address
3629 VISTA WAY, OCEANSIDE, CA 92056-4522
(760) 828-9201
(760) 828-9141
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070001860
RAILROAD MEDICARE
CA
05
—
GR0029460
—
CA
Enumeration date
05/31/2006
Last updated
02/02/2009
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