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PACIFIC DERMATOLOGY INSTITUTE
NPI 1740410182
Dermatology in Corona, CA

Active since July 20, 2009CLIA Certified · 5 labs
770 MAGNOLIA AVE STE 1H, CORONA, CA 92879(951) 734-8989 Get Directions Write a Review

NPPES record last updated: August 29, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 7, 2023, Aug 24, 2021, Mar 29, 2020 and 1 more (4 updates tracked since 2018).

About Pacific Dermatology Institute NPPES

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

PACIFIC DERMATOLOGY INSTITUTE (NPI 1740410182) is a healthcare organization registered as a dermatology in Corona, California and active in the NPI registry since July 2009. The organization holds 5 active CLIA laboratory certificates, maintains 15 additional practice locations, and lists Bradley Pierce Mudge, President, as its authorized official.

NPPES Registry Identity

NPI1740410182
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePACIFIC DERMATOLOGY INSTITUTE
Location Address770 MAGNOLIA AVE STE 1HCorona, CA 92879-3121
Mailing Address1200 California St Ste 210Redlands, CA 92374-2948 · (909) 693-3424
Phone(951) 734-8989
Organization SubpartNo
Authorized OfficialBradley Pierce MudgePresident · (951) 354-2220
Enumeration DateJuly 20, 2009
Last NPPES UpdateAugust 29, 20254 updates tracked since enumeration
NPPES CertifiedAugust 29, 2025
✔ NPI 1740410182 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X
770 MAGNOLIA AVE STE 1H, Corona, CA 92879
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Secondary Practice Locations 15

Location 11666 N Waterman AveSan Bernardino, CA 92404-5113 · Phone (909) 886-4965
Location 2585 N Mountain Ave Ste AUpland, CA 91786-8516 · Phone (909) 608-7546
Location 39041 Magnolia Ave Ste 206Riverside, CA 92503-3956 · Phone (951) 354-2220
Location 4255 Terracina Blvd Ste 205CRedlands, CA 92373-4870 · Phone (909) 793-2323
Location 51481 Ford St Ste 102Redlands, CA 92373-3917 · Phone (909) 793-2323
Location 618523 Corwin Rd Ste GApple Valley, CA 92307-2300 · Phone (760) 242-3376
Location 72140 Grand Ave Ste 260Chino Hills, CA 91709-6806 · Phone (909) 464-9800
Location 81801 E Tahquitz Canyon Way Ste 103Palm Springs, CA 92262-7121 · Phone (760) 537-5561 · Fax (760) 537-5564
Location 911340 Mountain View Ave Ste B1Loma Linda, CA 92354-3884 · Phone (909) 918-4000 · Fax (909) 918-4110
Location 1044605 Avenida De Missiones Ste 202Temecula, CA 92592-5001 · Phone (951) 446-1999 · Fax (951) 446-1984
Location 1125405 Hancock Ave Ste 200Murrieta, CA 92562-5978 · Phone (951) 200-2090
Location 1274090 El Paseo Ste 103Palm Desert, CA 92260-4135 · Phone (760) 341-8244
Location 13240 Newport Center Dr Ste 105, Suite 105Newport Beach, CA 92660 · Phone (951) 354-2220 · Fax (951) 354-2218
Location 147281 Dumosa Ave Ste 3Yucca Valley, CA 92284-3781 · Phone (760) 365-7546
Location 1516465 Sierra Lakes Pkwy Ste 275Fontana, CA 92336-1263 · Phone (909) 279-1010

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 MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pacific Dermatology Institute is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

20

Medicare enrollment records show 20 clinicians reassign Medicare billing to Pacific Dermatology Institute, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Dermatology11
Nurse Practitioner7
Pathology1
Plastic and Reconstructive Surgery1

Clinicians, nearest first (20)

Babak Roshdieh, M.D.
Dermatology
NPI 1275589723
770 MAGNOLIA AVE SUITE 2G
Corona, CA 92879
(951) 734-6500
✔ PECOS✔ Accepts MedicareSame address
Vincent Fowler, MD
Dermatology
NPI 1548368749
9041 MAGNOLIA AVE STE 206
Riverside, CA 92503
(951) 354-2220
✔ PECOS✔ Accepts Medicare8.1 mi
Louis Pham, FNP-C
Nurse Practitioner
NPI 1235897281
585 N MOUNTAIN AVE STE A
Upland, CA 91786
(909) 500-4574
✔ PECOS✔ Accepts Medicare18 mi
Nagi Saied, M.D.
Dermatology
NPI 1962556548
26732 CROWN VALLEY PKWY SUITE 461
Mission Viejo, CA 92691
(949) 264-3305
✔ PECOS✔ Accepts Medicare21 mi
Erica Kim, NP
Nurse Practitioner
NPI 1124500087
27640 EUCALYPTUS AVE
Moreno Valley, CA 92555
(951) 243-2200
✔ PECOS✔ Accepts Medicare22 mi
Joyce Yuan, M.D.
Dermatology
NPI 1972940187
360 SAN MIGUEL DR STE 501
Newport Beach, CA 92660
(949) 720-1170
✔ PECOS✔ Accepts Medicare25 mi
Bradley Mudge, MD
Plastic and Reconstructive Surgery
NPI 1891764700
240 NEWPORT CENTER DRIVE SUITE 105
Newport Beach, CA 92660
(949) 644-2450
✔ PECOS✔ Accepts Medicare25 mi
Marie Hampton, FNP
Nurse Practitioner
NPI 1194495440
57463 29 PALMS HWY STE 201
Yucca Valley, CA 92284
(800) 748-3243
✔ PECOS✔ Accepts Medicare25 mi
101 E REDLANDS BLVD STE 284
Redlands, CA 92373
(909) 707-5979
✔ PECOS✔ Accepts Medicare25 mi
Ryan Donlon, FNP-BC
Nurse Practitioner
NPI 1023609401
24400 JACKSON AVE STE B
Murrieta, CA 92562
(951) 433-5410
✔ PECOS✔ Accepts Medicare28 mi
Carmen Huerta, NP-C
Nurse Practitioner
NPI 1871910950
25405 HANCOCK AVE STE 200
Murrieta, CA 92562
(951) 200-2090
✔ PECOS✔ Accepts Medicare30 mi
Matthew Willett, M.D.
Dermatology
NPI 1720328107
NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
Camp Pendleton, CA 92055
(760) 719-3249
✔ PECOS✔ Accepts Medicare33 mi
Shiva Kheradmand, DO
Dermatology
NPI 1457884298
44605 AVENIDA DE MISSIONES STE 202
Temecula, CA 92592
(727) 588-5200
✔ PECOS✔ Accepts Medicare37 mi
Sarah Hurd
Nurse Practitioner
NPI 1871102590
71777 SAN JACINTO DR STE 202
Rancho Mirage, CA 92270
(888) 743-7526
✔ PECOS✔ Accepts Medicare66 mi
Jonathan Igo, FNP-C
Nurse Practitioner
NPI 1215476643
200 W ARBOR DR
San Diego, CA 92103
(800) 926-8273
✔ PECOS✔ Accepts Medicare79 mi
Eric Sako
Dermatology
NPI 1982022166
388 E YOSEMITE AVE STE 100
Merced, CA 95340
(209) 722-7801
✔ PECOS✔ Accepts Medicare290 mi
Clemens Esche, M.D.
Dermatology
NPI 1790826394
5575 W LAS POSITAS BLVD STE 260
Pleasanton, CA 94588
(925) 847-3020
✔ PECOS✔ Accepts Medicare359 mi
Thomas Munyon
Dermatology
NPI 1568481588
262 REDWOOD SHORES PKWY
Redwood City, CA 94065
(650) 654-6020
✔ PECOS✔ Accepts Medicare365 mi
Bruce Maltz, M.D.
Dermatology
NPI 1871694315
280 BALDWIN AVE
San Mateo, CA 94401
(650) 344-1121
✔ PECOS✔ Accepts Medicare371 mi
Kevin Patel, MD
Dermatology
NPI 1851850721
6000 W SPRING CREEK PKWY STE 200
Plano, TX 75024
(972) 316-4555
✔ PECOS✔ Accepts Medicare1,196 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 14

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 05D2257957

Pacific Dermatology Institute · Palm Desert, CA
Active · expires Jun 4, 2027
CLIA Number05D2257957
Laboratory TypePhysician Office
Certificate Effective DateJune 5, 2025
Certificate Expiration DateJune 4, 2027
Laboratory DirectorEric Y. Sako
Laboratory Phone(760) 341-8244
Laboratory LocationPacific Dermatology Institute74090 El Paseo, Ste 103, Palm Desert, CA 92260
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.

Certificate of Compliance 05D2324694

Pacific Dermatology Institute · Fontana, CA
Active · expires May 28, 2027
CLIA Number05D2324694
Laboratory TypePhysician Office
Certificate Effective DateMay 29, 2025
Certificate Expiration DateMay 28, 2027
Laboratory DirectorMona Deerwester
Laboratory Phone(909) 279-1010
Laboratory LocationPacific Dermatology Institute16465 Sierra Lakes Pkwy, Ste 275, Fontana, CA 92336
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.

Certificate of Compliance 05D2295760

Pacific Dermatology Institute · Redlands, CA
Active · expires Aug 3, 2027
CLIA Number05D2295760
Laboratory TypePhysician Office
Certificate Effective DateAugust 4, 2025
Certificate Expiration DateAugust 3, 2027
Laboratory DirectorDr. Mona Deerwester
Laboratory Phone(909) 789-0816
Laboratory LocationPacific Dermatology Institute1200 California St Ste 210, Redlands, CA 92374
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 05D2294451

Pacific Dermatology Institute · Yucca Valley, CA
Active · expires Nov 24, 2027
CLIA Number05D2294451
Laboratory TypePhysician Office
Certificate Effective DateNovember 25, 2025
Certificate Expiration DateNovember 24, 2027
Laboratory DirectorMona Deerwester
Laboratory Phone(760) 365-7546
Laboratory LocationPacific Dermatology Institute57463 29 Palms Hwy, Ste 201, Yucca Valley, CA 92284
CLIA data matches this NPI record on: 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.

Certificate of Compliance 05D2328035

Pacific Dermatology Institute · Menifee, CA
Active · expires Aug 3, 2027
CLIA Number05D2328035
Laboratory TypePhysician Office
Certificate Effective DateAugust 4, 2025
Certificate Expiration DateAugust 3, 2027
Laboratory DirectorMona Deerwester
Laboratory Phone(951) 446-1999
Laboratory LocationPacific Dermatology Institute29798 Haun Rd Ste 104, Menifee, CA 92586
CLIA data matches this NPI record on: 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.

Certificate of Compliance 05D2166471

Pacific Dermatology Institute · Redlands, CA
Expired · Oct 22, 2026
CLIA Number05D2166471
Laboratory TypePhysician Office
Certificate Effective DateOctober 23, 2024
Certificate Expiration DateOctober 22, 2026
Laboratory DirectorDr. Thomas G. Munyon
Laboratory Phone(909) 793-2323
Laboratory LocationPacific Dermatology Institute255 Terracina Blvd, Ste 205C, Redlands, CA 92373
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 Pacific Dermatology Institute's NPI number?

The NPI number for Pacific Dermatology Institute is 1740410182. It was assigned to this organization in the NPPES registry on July 20, 2009.

Where is Pacific Dermatology Institute located?

Pacific Dermatology Institute is located at 770 Magnolia Ave Ste 1H, Corona, CA 92879. The listed phone number is (951) 734-8989.

What is Pacific Dermatology Institute's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Pacific Dermatology Institute enrolled in Medicare?

Yes. Pacific Dermatology Institute is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pacific Dermatology Institute?

According to the CMS Revalidation Reassignment List (October 2026 release), 20 clinicians in 4 Medicare specialties reassign their Medicare billing to Pacific Dermatology Institute. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (11), Nurse Practitioner (7) and Pathology (1). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pacific Dermatology Institute hold CLIA laboratory certificates?

Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Pacific Dermatology Institute was last updated on August 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.