Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A83828 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A83838 | CA |
N | 207ND0900X | Dermatopathologist | A83828 | CA |
N | 207NP0225X | Pediatric Dermatologist | A83828 | CA |
N | 207NS0135X | Procedural Dermatology | A83828 | CA |
NPI | 1245450766 |
---|---|
Provider Name | Dr. Tanya Kormeili |
First Address | Santa Monica, CA 90403-4823 |
Second Address | Santa Monica, CA 90403-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WA83828A | MEDICARE PIN (01) |