Healthcare Provider Details

I. General information

NPI: 1801417316
Provider Name (Legal Business Name): ARTIUS DERMATOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 COTTAGE AVE
MANTECA CA
95336-4942
US

IV. Provider business mailing address

PO BOX 101868
PASADENA CA
91189-0055
US

V. Phone/Fax

Practice location:
  • Phone: 209-624-7006
  • Fax: 209-554-4601
Mailing address:
  • Phone: 956-803-0748
  • Fax: 956-803-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: RONALD MISTAK
Title or Position: CFO
Credential:
Phone: 361-248-1505