| NPI | 1770351041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEJASWI V MUDIGONDA CEO 551-208-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207NS0135X Dermatology Procedural Dermatology | |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-04-07 |