Derrek Giansiracusa
Dermatology in Glendale, AZ. Individual provider (NPI-1).
NPI number1154023737
StatusActive
Last updated in NPPESMar 25, 2025
Details
- NPI
- 1154023737
- Entity type
- Individual (NPI-1)
- Name
- Derrek Giansiracusa
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 20, 2023
- Certification date
- Mar 25, 2025
- Last updated
- Mar 25, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | 011498 | AZ | Yes |
Practice location
11851 N 51st Ave Ste E130Glendale, AZ 85304-2843
Phone 623-299-9540
Mailing address
11851 N 51st Ave Ste E130Glendale, AZ 85304-2843
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