Provider Demographics
NPI:1992680268
Name:MESOBAR PC
Entity type:Organization
Organization Name:MESOBAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKORNEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-325-9161
Mailing Address - Street 1:9615 BRIGHTON WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5118
Mailing Address - Country:US
Mailing Address - Phone:818-325-9161
Mailing Address - Fax:
Practice Address - Street 1:9615 BRIGHTON WAY STE 400
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5118
Practice Address - Country:US
Practice Address - Phone:818-325-9161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty