Healthcare Provider Details

I. General information

NPI: 1508313602
Provider Name (Legal Business Name): ATOS DERMATOPATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 N JOHN WAYNE PKWY #116
MARICOPA AZ
85139-8979
US

IV. Provider business mailing address

2349 E BECKER LN
PHOENIX AZ
85028-3105
US

V. Phone/Fax

Practice location:
  • Phone: 312-502-9389
  • Fax:
Mailing address:
  • Phone: 312-502-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number42919
License Number StateAZ

VIII. Authorized Official

Name: CARLOS FREDERICO RODRIGUEZ
Title or Position: OWNER
Credential: M.D.
Phone: 312-502-9389