Coastal Medical and Cosmetic Dermatology INC

NPI #1346488004 in La Jolla, California

Provider Information

NPI Number: 1346488004
Entity Type: Organization
Organization Name: Coastal Medical and Cosmetic Dermatology INC
Primary Specialty: Dermatology
Enumeration Date: Feb 3, 2009
Last Updated: Dec 17, 2015

Practice Location

Address: 9850 GENESEE AVE STE 500
City: La Jolla
State: California
ZIP Code: 92037-1213
Phone: (858) 657-0267

Authorized Official

Name: DR. DARRELL WAYNE GONZALES, M.D.
Title: OWNER, PRESIDENT, CFO
Phone: (858) 657-0267

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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