Provider Demographics
NPI:1972230217
Name:DERMDOCS
Entity type:Organization
Organization Name:DERMDOCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-375-3653
Mailing Address - Street 1:12707 HIGH BLUFF DR STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3003
Mailing Address - Country:US
Mailing Address - Phone:858-293-1152
Mailing Address - Fax:
Practice Address - Street 1:1022 N EL CAMINO REAL # 134
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1320
Practice Address - Country:US
Practice Address - Phone:858-293-1152
Practice Address - Fax:858-780-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty