MEDICARE: NO ARIZ DERMATOLOGY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03D0053373	OTHER		CLIA

General Provider Information

NPI Number	:	1932244266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NO ARIZ DERMATOLOGY CENTER

Provider Business Mailing Address
First Line	:	1490 N TURQUOISE DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001
Country	:	US
Telephone Number	:	928-774-5074
Fax Number	:	928-779-0884

Provider Business Practice Location Address
First Line	:	1490 N TURQUOISE DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001
Country	:	US
Telephone Number	:	928-774-5074
Fax Number	:	928-779-0884

Authorized Official
Title or Position	:	CEO
Name	:	DR. SARA JOY RISNER-RUMOHR
Credential	:	MD
Telephone Number	:	928-774-5074

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/18/2026

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