Provider Demographics
NPI:1588054431
Name:KURLAN DERMATOLOGY MEDICAL CENTER, INC
Entity type:Organization
Organization Name:KURLAN DERMATOLOGY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KURLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-302-1302
Mailing Address - Street 1:31515 RANCHO PUEBLO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4837
Mailing Address - Country:US
Mailing Address - Phone:951-302-1302
Mailing Address - Fax:760-239-6893
Practice Address - Street 1:31515 RANCHO PUEBLO RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4837
Practice Address - Country:US
Practice Address - Phone:951-302-1302
Practice Address - Fax:760-239-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51819207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty