| Dermatology West, Llc | |
|
26410 Center Ridge Rd Westlake OH 44145-4067 | |
| (440) 858-3176 | |
| Not Available |
| Full Name | Dermatology West, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 26410 Center Ridge Rd, Westlake, Ohio |
| Authorized Official Name and Position | Kyle Loren Wagamon (OWNER) |
| Authorized Official Contact | 4408583176 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dermatology West, Llc 1445 Castro St San Francisco CA 94114-3717 Ph: (440) 858-3176 | Dermatology West, Llc 26410 Center Ridge Rd Westlake OH 44145-4067 Ph: (440) 858-3176 |
| NPI Number | 1053521021 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053521021 | NPI | - | NPPES |
| 1780758003 | Other | CA | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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