Organization
DERMATOLOGY SURGICAL & MEDICAL GROUP
Active
Organization
DERMATOLOGY SURGICAL & MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA NILES (OFFICE MANAGER)
(831) 476-2444
Entity
Organization
Contact information
Practice address
1661 SOQUEL DR, BUILDING E, SANTA CRUZ, CA 95065
(831) 476-2444
(831) 476-3271
Mailing address
1661 SOQUEL DR, BUILDING E, SANTA CRUZ, CA 95065-1709
(831) 476-2444
(831) 476-3271
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0053090
—
CA
Enumeration date
09/20/2006
Last updated
06/26/2018
Update your record
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