Provider Demographics
NPI:1144265893
Name:ABLON SKIN INSTITUTE
Entity type:Organization
Organization Name:ABLON SKIN INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLYNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-376-6262
Mailing Address - Street 1:PO BOX 2866
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90509-2866
Mailing Address - Country:US
Mailing Address - Phone:310-792-0601
Mailing Address - Fax:
Practice Address - Street 1:1600 ROSECRANS AVE
Practice Address - Street 2:BLDG 6A, SUITE 12
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3708
Practice Address - Country:US
Practice Address - Phone:310-727-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77280BMedicare ID - Type Unspecified
G39497Medicare UPIN