Organization
PACIFIC DERMATOLOGY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY BOTTOMLEY (PRACTICE ADMINISTRATOR)
(909) 362-2966
Entity
Organization
Contact information
Practice address
240 NEWPORT CENTER DR, SUITE 105, NEWPORT BEACH, CA 92660-7512
(946) 644-2450
(946) 644-2451
Mailing address
240 NEWPORT CENTER DR, SUITE 105, NEWPORT BEACH, CA 92660-7512
(946) 644-2450
(946) 644-2451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A79221
CA
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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