Provider Demographics
NPI:1861121741
Name:FOREFRONT DERMATOLOGY - PACIFIC, P.C.
Entity type:Organization
Organization Name:FOREFRONT DERMATOLOGY - PACIFIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WERNLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-482-0671
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:15055 LOS GATOS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2056
Practice Address - Country:US
Practice Address - Phone:408-356-1000
Practice Address - Fax:408-356-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty