Healthcare Provider Details

I. General information

NPI: 1306010467
Provider Name (Legal Business Name): BRENDA MARIE LATOWSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 N SCOTTSDALE HEALTHCARE DR SUITE 260
SCOTTSDALE AZ
85255-4134
US

IV. Provider business mailing address

20201 N SCOTTSDALE HEALTHCARE DR SUITE 260
SCOTTSDALE AZ
85255-4134
US

V. Phone/Fax

Practice location:
  • Phone: 480-398-1550
  • Fax: 480-398-1551
Mailing address:
  • Phone: 480-398-1550
  • Fax: 480-398-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number234038
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24408
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number41903
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1108516
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: