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General NPI Number Information
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NPI Number | 1801498704
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE SKIN BOUTIQUE AND DERMATOLOGY PLLC
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Dates
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Enumeration Date | 11/15/2020
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 11333 N SCOTTSDALE RD STE 115
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5186
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Country | US
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Telephone | 310-980-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 11333 N SCOTTSDALE RD STE 115
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5186
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Country | US
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Telephone | 480-998-1400
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GENEVIEVE EGNATIOS
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Credential | MD
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Telephone | 480-998-1400
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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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