DALE A KOOISTRA


Address: 15525 Pomerado Rd, Suite D2, Poway, CA 92064-2435
Phone: 8586758001

DALE A KOOISTRA (NPI# 1831182971) 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) 1831182971
Entity Type Individual
Full Name DALE A KOOISTRA
Credential M.D., PHD.
Practice Address 15525 Pomerado Rd
Suite D2
Poway
CA 92064-2435
Practice Telephone 8586758001
Practice Fax Number 8584871337
Mailing Telephone 8586758001
Mailing Fax Number 8584871337
Enumeration Date 2005-08-24
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor X

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology G55734 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA 00G557340 05

Office Location

Street Address 15525 POMERADO RD
SUITE D2
City POWAY
State CA
Zip Code 92064-2435

Providers in the same location

NPI Name Taxonomy Address Enumeration
1073519955 Debra Joan Abel Audiologist 15525 Pomerado Rd, E-1, Poway, CA 92064-2435 2005-06-24
1619412806 Waves, A Psychological Corporation Psychologist 15525 Pomerado Rd, Suite C-5, Poway, CA 92064-2435 2016-12-27
1083003586 San Diego Psychological Center Inc. Psychologist 15525 Pomerado Rd, Suite B3, Poway, CA 92064-2435 2015-01-21
1871994905 Tracy Daly Dietitian, Registered 15525 Pomerado Rd, Suite B-1, Poway, CA 92064-2435 2014-09-08
1144655507 Blue Skies Behavioral Health Clinic/Center 15525 Pomerado Rd, Suite B-1, Poway, CA 92064-2435 2013-09-04
1295088334 San Diego Diagnostic Radiology Medical Group, Inc. Clinic/Center 15525 Pomerado Rd, Suite E2, Poway, CA 92064-2435 2012-10-25
1598047086 Sarah L Jacobs-paul Counselor 15525 Pomerado Rd, Suite C-5, Poway, CA 92064-2435 2011-09-12
1568750438 Amanda Louise Peeler Physical Therapist 15525 Pomerado Rd, Ste D4, Poway, CA 92064-2435 2011-07-13
1952694408 Erika Swift Holtermann Psychologist 15525 Pomerado Rd, Suite B-1, Poway, CA 92064-2435 2011-05-17
1124310917 Cpte Physical Therapy Professional Corporation Physical Therapist 15525 Pomerado Rd, Ste D4, Poway, CA 92064-2435 2011-05-11
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1194357384 Prabha Choudhary Student in an Organized Health Care Education/Training Program 17555, Corte Lomas Verdes, Poway, CA 92064 2020-02-06
1770143968 Theresa Marie Morales In Home Supportive Care 15352 Running Deer Trl, Poway, CA 92064 2019-06-19
1689230997 Jaclyn Miller Audiologist Health Medical Group, 15525 Pomerado Road Suite C-1, Poway, CA 92064 2019-05-13
1205306842 Angelita Fuentes Behavior Technician 12975 Brookprinter Place Suite 250, Poway, CA 92064 2018-11-27
1396235271 Michael Cutler, M.d., P.C. Clinic/Center 12285 Scripps Poway Pkwy Ste 103, Poway, CA 92064 2018-05-16
1720576671 Jodi A Mcgrady Dmd, Ms, Adc Dentist 12350 Oak Knoll Rd, Poway, CA 92064 2018-04-26
1295237139 Michelle J. Beaupre Social Worker 204 Poway Rd., Poway, CA 92064 2018-03-07
1669918165 Restore Detox Centers Substance Abuse Rehabilitation Facility 14099 Sky Mountain Trail, Poway, CA 92064 2017-01-09
1205382561 Nightingale Meyou Pharmacist 5615 Pomerado Rd, Poway, CA 92064 2016-08-28
1578017232 Elan Lee Dentist 13035 Pomerado Road Suite B, Poway, CA 92064 2016-08-11
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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
1518425966 California Hair Extensions Dermatology 12759 Poway Rd Ste 101, Poway, CA 92064-4445 2019-03-05
1639550833 Naomi Travers Dermatology 15725 Poway Road, Suite 102, Poway, CA 92064-5138 2015-06-12
1356608319 Paul Chun-pu Jou Dermatology 15611 Pomerado Rd Ste 400, Poway, CA 92064-2437 2012-04-16
1366685737 Park Terrace Medical Associates Inc Dermatology 15611 Pomerado Rd, Suite 400, Poway, CA 92064-2437 2009-04-14
1306096680 Anne Kathleen Truitt Dermatology 15611 Pomerado Rd Ste 400, Poway, CA 92064-2437 2008-09-24
1376757625 E. Stanley Rodier, M.d.,frcpc,inc Dermatology 15725 Pomerado Rd, Suite 108, Poway, CA 92064-2068 2007-05-09
1134201312 Ernest Stanley Rodier, Frcpc,inc Dermatology 15725 Pomerado Road, Suite 108, Poway, CA 92064 2006-10-19
1912973868 Stephen Wells Shewmake Dermatology 15611 Pomerado Rd, Poway, CA 92064-2437 2006-02-28
1992786347 Diane M Scott Dermatology 15611 Pomerado Rd, Suite 400, Poway, CA 92064-2437 2005-11-10

Providers in the same taxonomy and state

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
1669081204 Lucy Boyadzhian Dermatology 7472 Melrose Ave, Los Angeles, CA 90046-7524 2020-07-29
1033730981 Adrianna Janell Browne, Md, Inc. Dermatology 8 Camino Encinas Ste 115, Orinda, CA 94563-3350 2020-05-01
1215564877 Jasmine Khachatrian Dermatology 302 Sierra Woods Dr, Sierra Madre, CA 91024-1015 2020-03-24
1386277499 Jessica Hsu, M.d.,inc Dermatology 1506 Chapman Avenue, Address Line 2, Orange, CA 92866 2020-02-17
1245862101 Yuval Bibi, A Professional Corporation Dermatology 7266 Franklin Ave Apt 321, Los Angeles, CA 90046-8324 2020-02-09
1457982001 Modesty Joy Isaguirre Dermatology 140 S Grand Ave, Glendora, CA 91741-4259 2020-02-03
1790322063 Mfc Dermatology Dermatology 3655 Lomita Blvd Ste 221, Torrance, CA 90505-1918 2019-12-05
1336784206 Barbara Kinkle Pa Inc., A Physician Assistant Corporation Dermatology 24575 Hunt Ave, Corning, CA 96021-8607 2019-11-14
1497399141 Dermatology Specialists Inc Dermatology 4765 Carmel Mountain Rd Ste 201, San Diego, CA 92130-6657 2019-11-05
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Competitor

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City POWAY
Zip Code 92064

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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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