Healthcare Provider Details

I. General information

NPI: 1447852488
Provider Name (Legal Business Name): ROSWELL SKIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE STE 920
ROSWELL NM
88201-4779
US

IV. Provider business mailing address

400 N PENNSYLVANIA AVE STE 920
ROSWELL NM
88201-4779
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-2509
  • Fax: 575-265-1700
Mailing address:
  • Phone: 575-208-2509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON COMETTI
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 713-553-9308