Organization
BLUE HARBOR DERMATOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BELASCO MD (PHYSICIAN)
(800) 828-2012
Entity
Organization
Contact information
Practice address
1501 SUPERIOR AVE, SUITE 115, NEWPORT BEACH, CA 92663-3600
(214) 395-2221
Mailing address
1501 SUPERIOR AVE, SUITE 115, NEWPORT BEACH, CA 92663-3600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20A12076
CA
Other
Enumeration date
03/24/2014
Last updated
03/24/2014
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