Healthcare Provider Details

I. General information

NPI: 1790020295
Provider Name (Legal Business Name): DEBORAH S. MENDELSON, MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 N 3RD ST STE 206
PHOENIX AZ
85020-2470
US

IV. Provider business mailing address

111 E DUNLAP AVE #1-471
PHOENIX AZ
85020-2807
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-4626
  • Fax: 602-396-5800
Mailing address:
  • Phone: 602-944-4626
  • Fax: 602-396-5800

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 S. MENDELSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 602-944-4626