Basic Information
| Provider Information | |||||||||
| NPI: | 1730526591 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CYRUS | ||||||||
| FirstName: | NIKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23781 MAQUINA | ||||||||
| Address2: | DERMATOLOGY DEPARTMENT, 2ND FLOOR | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926912716 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 23781 MAQUINA | ||||||||
| Address2: | 2ND FLOOR DERMATOLOGY DEPARTMENT | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926912716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889882800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A147357 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.