| NPI | 1639569825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANNTEJ SRA Owner 602-529-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-01-27 |