Provider Demographics
NPI:1326182411
Name:ENCINO DERMA SURGERY CENTER, INC.
Entity type:Organization
Organization Name:ENCINO DERMA SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:FINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-794-7422
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:310-794-7422
Mailing Address - Fax:310-208-2158
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:310-794-7422
Practice Address - Fax:310-208-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051717Medicare PIN