Healthcare Provider Details

I. General information

NPI: 1730293432
Provider Name (Legal Business Name): NORTH MOUNTAIN DERMATOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E DUNLAP AVE #105
PHOENIX AZ
85020-2877
US

IV. Provider business mailing address

50 E DUNLAP AVE #105
PHOENIX AZ
85020-2877
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-4626
  • Fax: 602-944-2805
Mailing address:
  • Phone: 602-944-4626
  • Fax: 602-944-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORAH MENDELSON
Title or Position: PRESIDENT
Credential: MD
Phone: 602-944-4626