Provider Demographics
NPI:1932994332
Name:DERM LOUNGE PC
Entity type:Organization
Organization Name:DERM LOUNGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:AWADALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-458-6668
Mailing Address - Street 1:113 WATERWORKS WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3176
Mailing Address - Country:US
Mailing Address - Phone:714-798-2900
Mailing Address - Fax:949-216-3232
Practice Address - Street 1:113 WATERWORKS WAY STE 210
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3176
Practice Address - Country:US
Practice Address - Phone:714-798-2900
Practice Address - Fax:949-216-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty