Provider Demographics
NPI:1316687411
Name:TRI CITY DERMATOLOGY A MEDICAL CORPORATION
Entity type:Organization
Organization Name:TRI CITY DERMATOLOGY A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-894-5616
Mailing Address - Street 1:15336 DEVONSHIRE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2766
Mailing Address - Country:US
Mailing Address - Phone:818-894-5616
Mailing Address - Fax:818-893-4872
Practice Address - Street 1:15336 DEVONSHIRE ST STE 1
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2766
Practice Address - Country:US
Practice Address - Phone:818-894-5616
Practice Address - Fax:818-893-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty