Healthcare Provider Details

I. General information

NPI: 1326252131
Provider Name (Legal Business Name): NEVADA CENTER FOR DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SIERRA ROSE DR STE. A
RENO NV
89511-2081
US

IV. Provider business mailing address

650 SIERRA ROSE DR STE. A
RENO NV
89511-2357
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-8100
  • Fax:
Mailing address:
  • Phone: 775-827-8100
  • Fax: 775-827-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8902
License Number StateNV

VIII. Authorized Official

Name: KENJI SAX
Title or Position: PRACTICE MANAGER
Credential:
Phone: 775-827-8100