PACIFIC DERMATOLOGY INSTITUTE


Address: 240 Newport Center Dr Ste 105, Suite 105, Newport Beach, CA 92660
Phone: 9513542220

PACIFIC DERMATOLOGY INSTITUTE (NPI# 1740410182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1740410182
Entity Type Organization
Organization Name PACIFIC DERMATOLOGY INSTITUTE
Practice Address 240 Newport Center Dr Ste 105
Suite 105
Newport Beach
CA 92660
Mailing Address 240 Newport Center Dr Ste 105
Suite 105
Newport Beach
CA 92660-7538
Practice Telephone 9513542220
Practice Fax Number 9513542218
Mailing Telephone 9513542220
Mailing Fax Number 9513542218
Enumeration Date 2009-07-20
Last Update Date 2020-03-29
Authorized Official Name DR. BRADLEY PIERCE MUDGE (PRESIDENT)
Authorized Official Telephone 9513542220
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207ND0101X Dermatology
Specialization: MOHS-Micrographic Surgery
Allopathic & Osteopathic Physicians
Y 207N00000X Dermatology Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
11340 Mountain View Ave Ste B1, Loma Linda, CA 923543884 9099184000 9099184110
1481 Ford St Ste 102, Redlands, CA 923733917 9097932323
1666 N Waterman Ave, San Bernardino, CA 924045113 9098864965
1801 E Tahquitz Canyon Way Ste 103, Palm Springs, CA 922627121 7605375561 7605375564
18523 Corwin Rd Ste G, Apple Valley, CA 923072300 7602423376
2140 Grand Ave Ste 260, Chino Hills, CA 917096806 9094649800
25405 Hancock Ave Ste 200, Murrieta, CA 925625978 9512002090
25405 Hancock Ave Ste 217, Murrieta, CA 925625978 9512002090
255 Terracina Blvd Ste 205c, Redlands, CA 923734870 9097932323
44605 Avenida De Missiones Ste 202, Temecula, CA 925925001 9514461999 9514461984
585 N Mountain Ave Ste A, Upland, CA 917868516 9096087546
770 Magnolia Ave Ste 1h, Corona, CA 928793121 9517348989
9041 Magnolia Ave Ste 206, Riverside, CA 925033956 9513542220

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1922486117 Pacific Dermatology Institute Dermatology 240 Newport Center Dr, Suite 105, Newport Beach, CA 92660-7512 2015-05-08

Office Location

Street Address 240 NEWPORT CENTER DR STE 105
SUITE 105
City NEWPORT BEACH
State CA
Zip Code 92660

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1275144024 Lumins Aesthetic and Wellness, Inc Dermatology 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 2020-08-14
1205445798 Felecia A Pedrogo Marriage & Family Therapist 5020 Campus Street, Newport Beach, CA 92660 2020-07-30
1649898388 Polyviou Dental Corportation, Inc. Clinic/Center 120 Newport Beach Drive, Suite 27, Newport Beach, CA 92660 2020-07-09
1154974525 Jan M. Eckermann, Md Inc. Neurological Surgery 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 2019-07-24
1235792219 Horizon Dermatology and Laser Institute Dermatology 369 San Miguel Dr. Suite 200, Newport Beach, CA 92660 2019-04-16
1902366925 Yasmine Central Gohar Marriage & Family Therapist 20271 Sw Birch St Ste 200, Newport Beach, CA 92660 2019-03-25
1245703255 Charison Counseling Counselor 4000 Macarthur Bvd Suite 600 East Tower, Newport Beach, CA 92660 2019-01-03
1134698996 Amber Werner Chiropractor 4029 Westerly Place, Suite #115, Newport Beach, CA 92660 2018-11-21
1861969008 Healthy Me Oc Dietitian, Registered 4569 Macarthur Court, Suite 1100, Newport Beach, CA 92660 2018-10-25
1174015192 Edwin Enwia Clinic/Center 1000 Bristol St N Ste 1b, Newport Beach, CA 92660 2018-06-05
Find all providers in zip 92660

Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1275144024 Lumins Aesthetic and Wellness, Inc Dermatology 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 2020-08-14
1588917934 Michael Patrick O'brien Dermatology 623 Via Lido Nord, Newport Beach, CA 92663-5549 2012-10-23
1457614919 Donna Tran Dermatology 495 Old Newport Blvd Ste 200, Newport Beach, CA 92663-4204 2012-06-20
1902171341 Dana Lee-anne Ellis Dermatology 400 Newport Center Dr Ste 702, Newport Beach, CA 92660-7669 2012-03-19
1417228644 Monica Bonakdar Dermatology 20321 Irvine Ave Ste F3, Newport Beach, CA 92660-0269 2012-01-19
1447531017 Samreen Choudhry Dermatology 1617 Westcliff Dr Ste 214, Newport Beach, CA 92660 2011-09-08
1578736724 Kevin Tate Belasco Dermatology 1501 Superior Ave Ste 115, Newport Beach, CA 92663-3606 2008-04-09
1679769954 Zenovia Hatziris Gabriel Dermatology 359 San Miguel Dr Ste 300, Newport Beach, CA 92660-7809 2007-09-19
1336278720 Kay Keeyeul Sung Dermatology 1525 Superior Ave Ste 210, Newport Beach, CA 92663-3656 2007-03-03
1932283561 Donna Marie West Dermatology 5140 Birch St, Ste #100, Newport Beach, CA 92660-2169 2006-10-24
Find all providers in NEWPORT BEACH

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City NEWPORT BEACH
Zip Code 92660

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Dataset Information

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.

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