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General NPI Number Information
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NPI Number | 1780229625
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Entity Type | Organization
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Legal Business Name | OASIS DERMATOLOGY PC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 1055 N LA CANADA DR STE 101
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-3700
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Country | US
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Telephone | 520-589-2039
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Fax | 520-230-4544
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Provider Business Mailing Address
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Address Line | 4729 E SUNRISE DR # 207
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City | TUCSON
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State | AZ
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Zip | 85718-4534
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Country | US
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Telephone | 520-589-2039
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA A LEYO-DUPONT
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Credential | MD
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Telephone | 520-589-2039
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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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