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GARDENA DERMATOLOGY
NPI 1619351707
Specialist in El Segundo, CA

Active since July 17, 2015
713 N DOUGLAS ST., EL SEGUNDO, CA 90245(310) 906-2788(310) 906-2786 Get Directions Write a Review

NPPES record last updated: August 11, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 11, 2022, Mar 24, 2021, Feb 11, 2020 and 3 more (6 updates tracked since 2016).

About Gardena Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARDENA DERMATOLOGY (NPI 1619351707) is a healthcare organization registered as a specialist in El Segundo, California and active in the NPI registry since July 2015. The organization lists Brenda Fellman, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1619351707
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameEL SEGUNDO DERMATOLOGY, INC.
Location Address713 N DOUGLAS ST.El Segundo, CA 90245
Mailing Address713 N. Douglas St.El Segundo, CA 90245 · (310) 906-2788 · Fax (310) 906-2786
Phone(310) 906-2788
Fax(310) 906-2786
Organization SubpartNo
Authorized OfficialBrenda FellmanPractice Manager · (310) 906-2788
Enumeration DateJuly 17, 2015
Last NPPES UpdateAugust 11, 20226 updates tracked since enumeration
NPPES CertifiedAugust 11, 2022
✔ NPI 1619351707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
713 N DOUGLAS ST., El Segundo, CA 90245
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Other Names 1

Doing Business AsGardena Dermatology

Other Identifiers 1

Medicaid100120719CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D2113648

El Segundo Dermatology Inc · El Segundo, CA
Expired · Jun 30, 2026
CLIA Number05D2113648
Laboratory TypePhysician Office
Certificate Effective DateFebruary 9, 2023
Certificate Expiration DateJune 30, 2026
Laboratory DirectorJill H. Javahery
Laboratory Phone(310) 906-2788
Laboratory LocationEl Segundo Dermatology Inc713 N Douglas St, El Segundo, CA 90245
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is El Segundo Dermatology, Inc.'s NPI number?

The NPI number for El Segundo Dermatology, Inc. is 1619351707. It was assigned to this organization in the NPPES registry on July 17, 2015. The provider is doing business as Gardena Dermatology.

Where is El Segundo Dermatology, Inc. located?

El Segundo Dermatology, Inc. is located at 713 N Douglas St., El Segundo, CA 90245. The listed phone number is (310) 906-2788.

What is El Segundo Dermatology, Inc.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for El Segundo Dermatology, Inc. was last updated on August 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.