Provider Demographics
NPI:1174728513
Name:DERMATOLOGY ASSOCIATES OF ORANGE COUNTY, INC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF ORANGE COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-706-7766
Mailing Address - Street 1:31862 COAST HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6769
Mailing Address - Country:US
Mailing Address - Phone:949-706-7766
Mailing Address - Fax:949-706-2211
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6769
Practice Address - Country:US
Practice Address - Phone:949-706-7766
Practice Address - Fax:949-706-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-17
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABS7402299207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27790Medicare UPIN
CAI07384Medicare UPIN