| NPI | 1184232670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA IGOREVNA LUPAS Manager 907-691-4977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology | |
| 207NP0225X Dermatology Pediatric Dermatology | |
| 207NS0135X Dermatology Procedural Dermatology | |
| 207Q00000X Family Medicine | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery | |
| 261Q00000X Clinic/Center | |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2022-01-28 |