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General NPI Number Information
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NPI Number | 1154613016
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Entity Type | Organization
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Legal Business Name | MONTROSE DERMATOLOGY PLLC
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 2730 COMMERCIAL WAY
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-964-4036
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Fax | 970-964-4038
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Provider Business Mailing Address
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Address Line | 2730 COMMERCIAL WAY
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-964-4036
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Fax | 970-964-4038
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. RENATA MARISA RAZIANO
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Credential | MD
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Telephone | 970-964-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 46375
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License Number State | CO
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