Healthcare Provider Details

I. General information

NPI: 1225958549
Provider Name (Legal Business Name): SONORAN DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 W AGUA FRIA FWY STE 104
PHOENIX AZ
85027-7202
US

IV. Provider business mailing address

5254 E HASHKNIFE RD
PHOENIX AZ
85054-7195
US

V. Phone/Fax

Practice location:
  • Phone: 562-822-3930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS LEE
Title or Position: MEMBER
Credential: MD
Phone: 562-822-3930