Healthcare Provider Details

I. General information

NPI: 1891702957
Provider Name (Legal Business Name): ALLIANCE DERMATOLOGY & MOHS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E BELL RD 147
PHOENIX AZ
85032
US

IV. Provider business mailing address

4045 E BELL RD 147
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-0268
  • Fax: 602-971-1556
Mailing address:
  • Phone: 602-971-0268
  • Fax: 602-971-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD G BOTTIGLIONE
Title or Position: OWNER
Credential: MD
Phone: 602-971-0268