| NPI | 1497270664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINY GYPSYLEE MATTOX Practice Manager 520-333-5973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2023-03-30 |