| NPI | 1871851691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE BERGER Practice Manager 480-855-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 45370) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: AZ 45370) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 29461) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2024-03-07 |