Omni Dermatology Incorporated
Dermatology in Glendale, AZ. Organization (NPI-2).
NPI number1003082090
StatusActive
Last updated in NPPESApr 3, 2024
Details
- NPI
- 1003082090
- Entity type
- Organization (NPI-2)
- Legal business name
- Omni Dermatology Incorporated
- Organization subpart
- No
- Enumeration date
- Apr 30, 2008
- Certification date
- Apr 3, 2024
- Last updated
- Apr 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 4311 | AZ | Yes |
Practice location
11851 N 51st Ave Ste E130Glendale, AZ 85304-2843
Phone 480-954-3919 · Fax 480-954-3670
Mailing address
11851 N 51st Ave Ste E130Glendale, AZ 85304-2843
Phone 236-299-9540
Authorized official
Andrew J Racette
President
6023693634
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