Provider Demographics
NPI:1306405998
Name:MISMO DERMATOLOGY GROUP APC
Entity type:Organization
Organization Name:MISMO DERMATOLOGY GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-621-4303
Mailing Address - Street 1:8898 NAVAJO RD STE C-349
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2141
Mailing Address - Country:US
Mailing Address - Phone:619-303-3704
Mailing Address - Fax:
Practice Address - Street 1:8898 NAVAJO RD STE C-349
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2141
Practice Address - Country:US
Practice Address - Phone:619-303-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty