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General NPI Number Information
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NPI Number | 1225674450
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Entity Type | Organization
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Legal Business Name | DESERT DERMATOLOGY & SKIN CANCER SPECIALISTS, P.C.
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 1400 N GILBERT RD STE L
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City | GILBERT
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State | AZ
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Zip | 85234-2327
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Country | US
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Telephone | 714-822-5969
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Fax |
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Provider Business Mailing Address
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Address Line | 31938 TEMECULA PKWY STE A337
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City | TEMECULA
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State | CA
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Zip | 92592-6810
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Country | US
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Telephone | 714-822-5969
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Fax | 951-303-2900
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JESSE DAVID MITCHELL
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Credential | M.D.
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Telephone | 714-822-5969
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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 |
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License Number State |
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