NOVATO DERMATOLOGY ASSOCIATES A MEDICAL CORPORATION

867 DIABLO AVE, NOVATO, CA, 949474007

atlas:atm_npi_1003960063

Block 4000Block Group 4Census Tract 1032Marin County California United States

What is stored

phone: 415-892-0754
status: A
address: 867 DIABLO AVE, NOVATO, CA, 949474007
fax: 415-897-3204
npi: 1003960063
license: G79619
taxonomy: Dermatology
other names: []
last updated: 2018-11-08
license state: CA
taxonomy code: 207N00000X
all taxonomies: ["Dermatology"]
enumeration date: 2007-01-23
enumeration type: NPI-2
practice locations: 0
authorized official: KIM FREDERICKSON
organizational subpart: NO

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{
  "fax": "415-897-3204",
  "npi": "1003960063",
  "phone": "415-892-0754",
  "status": "A",
  "address": "867 DIABLO AVE, NOVATO, CA, 949474007",
  "license": "G79619",
  "taxonomy": "Dermatology",
  "other_names": [],
  "last_updated": "2018-11-08",
  "license_state": "CA",
  "taxonomy_code": "207N00000X",
  "all_taxonomies": [
    "Dermatology"
  ],
  "enumeration_date": "2007-01-23",
  "enumeration_type": "NPI-2",
  "practice_locations": 0,
  "authorized_official": "KIM FREDERICKSON",
  "organizational_subpart": "NO"
}