Provider Demographics
NPI:1871326363
Name:O & P DERMATOLOGY ASSOCIATES
Entity type:Organization
Organization Name:O & P DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHADIAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-598-9939
Mailing Address - Street 1:20270 KLINE LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3269
Mailing Address - Country:US
Mailing Address - Phone:714-598-9939
Mailing Address - Fax:
Practice Address - Street 1:3028 E COAST HWY
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2209
Practice Address - Country:US
Practice Address - Phone:714-598-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty