GROSSMONT DERMATOLOGY MEDICAL CLINIC (NPI# 1194838441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194838441 |
| Entity Type | Organization |
| Organization Name | GROSSMONT DERMATOLOGY MEDICAL CLINIC |
| Practice Address |
8860 Center Dr Ste 300 La Mesa CA 91942-3068 |
| Practice Telephone | 6194621670 |
| Practice Fax Number | 6194623209 |
| Mailing Telephone | 6194621670 |
| Mailing Fax Number | 6194623209 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-09-24 |
| Authorized Official Name | MISS MONICA DEL VALLE (BILLING SUPERVISOR) |
| Authorized Official Telephone | 6194621670 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A233400 | 05 | |
| CA | 00G733400 | 05 |
| Street Address |
8860 CENTER DR STE 300 |
| City | LA MESA |
| State | CA |
| Zip Code | 91942-3068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578561692 | Robert Edward Bushman | Dermatology | 8860 Center Dr, Ste 300, La Mesa, CA 91942-3068 | 2005-07-12 |
| 1598137184 | Mccormack Dental Imaging | Dental Laboratory | 8860 Center Dr, Ste. 340, La Mesa, CA 91942-3068 | 2015-10-22 |
| 1982000816 | Lindsay Marie Warner | Nurse Practitioner | 8860 Center Dr, Suite 210, La Mesa, CA 91942-3068 | 2014-11-04 |
| 1467876771 | Joyce M Mancini | Nurse Practitioner | 8860 Center Dr, Ste 320, La Mesa, CA 91942-7001 | 2014-02-06 |
| 1407148216 | Scott Recksiedler | Dentist | 8860 Center Dr, Suite 460, La Mesa, CA 91942-3068 | 2011-05-11 |
| 1427378363 | Barzan Mohedin, Md, A Professional Corporation | Internal Medicine | 8860 Center Dr, Suite 310, La Mesa, CA 91942-3068 | 2010-06-02 |
| 1295963460 | Firas Alhaddad | Internal Medicine | 8860 Center Dr, #240, La Mesa, CA 91942-3068 | 2009-06-26 |
| 1760626477 | Hassan Kafri Md, Inc. | Internal Medicine | 8860 Center Dr, Suite 320, La Mesa, CA 91942-3068 | 2009-04-24 |
| 1881847044 | Brian Terumi Nagai | Dentist | 8860 Center Dr, Suite 430, La Mesa, CA 91942-3068 | 2008-10-30 |
| 1497931380 | Christopher V Crosby | Dermatology | 8860 Center Dr, Suite 300, La Mesa, CA 91942-3068 | 2008-01-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902453723 | Nicole V Zappelli | Case Manager/Care Coordinator | 4990 William Ave., La Mesa, CA 91942 | 2019-08-26 |
| 1770059834 | Natalie Ngoc Nguyen | Physician Assistant | 5555 Grosmont Center Dr., La Mesa, CA 91942 | 2018-10-16 |
| 1194204297 | Courtney Pietsch | Nurse Practitioner | 8851 Health Center Circle, Suite #603, La Mesa, CA 91942 | 2018-08-09 |
| 1295214773 | Megan Gordon | Behavior Technician | 6116 Horton Dr, La Mesa, CA 91942 | 2018-08-07 |
| 1356836548 | Kimberly Denise Davis | Counselor | 3845 Avocado School Road, El Cajon, CA 91942 | 2018-06-29 |
| 1366932113 | Melanie Joyce Shepard | Physician Assistant | 7051 Alvarado Road, Suite 201, La Mesa, CA 91942 | 2018-05-17 |
| 1871013532 | Low Dental, A.p.c. | Public Health or Welfare | 7872 La Mesa Blvd., La Mesa, CA 91942 | 2017-06-23 |
| 1275069437 | Ardel Ayala | Respiratory Therapist, Registered | 5800 Lake Murray Blvd. Unit 15, La Mesa, CA 91942 | 2017-05-10 |
| 1285007583 | Counseling & Behavioral Specialists | Marriage & Family Therapist | 5520 Wellesley Street, Ste 204, La Mesa, CA 91942 | 2015-11-09 |
| 1285001875 | Emily Shozaki Rizo | Nurse Practitioner | 6285 Meadowcrest Drive, La Mesa, CA 91942 | 2015-08-31 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396304986 | San Diego Dermatology Partners Apc | Dermatology | 7918 El Cajon Blvd Ste N186, La Mesa, CA 91942-6719 | 2019-06-07 |
| 1043664600 | Tanya Kaur Greywal | Dermatology | 8881 Fletcher Pkwy Ste 104, La Mesa, CA 91942-3131 | 2016-04-20 |
| 1205130036 | Shinko Lin | Dermatology | 8860 Center Dr Ste 300, La Mesa, CA 91942-7001 | 2011-01-10 |
| 1497789747 | Katherine S Fields | Dermatology | 7862 El Cajon Blvd, La Mesa, CA 91941-3625 | 2006-07-11 |
| 1235101346 | Minal Damani Jackson | Dermatology | 8080 Parkway Dr, La Mesa Medical Offices, La Mesa, CA 91942-2104 | 2006-02-02 |
| 1578561692 | Robert Edward Bushman | Dermatology | 8860 Center Dr, Ste 300, La Mesa, CA 91942-3068 | 2005-07-12 |
| 1174926190 | Sam Khalifian | Dermatology | 8860 Center Dr Ste 300, La Mesa, CA 91942-7001 | 2014-10-05 |
| 1811239064 | Wiggin W Lee | Dermatology | 8860 Center Dr Ste 300, La Mesa, CA 91942-7001 | 2013-03-25 |
| 1174813356 | Jessica Kim So | Dermatology | 7862 El Cajon Blvd, La Mesa, CA 91942-6712 | 2011-04-08 |
| 1073759627 | Tina S Chen | Dermatology | 7862 El Cajon Blvd, La Mesa, CA 91942-6712 | 2009-01-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.