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General NPI Number Information
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NPI Number | 1861813156
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Entity Type | Organization
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Legal Business Name | ALLIANCE DERMATOLOGY & MOHS CENTER, PC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 4045 E BELL RD SUITE 125
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City | PHOENIX
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State | AZ
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Zip | 85032-2238
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Country | US
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Telephone | 602-971-0268
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Fax | 602-971-1556
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Provider Business Mailing Address
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Address Line | 4045 E BELL RD SUITE 125
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City | PHOENIX
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State | AZ
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Zip | 85032-2238
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Country | US
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Telephone | 602-971-0268
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Fax | 602-971-1156
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Authorized Official
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Title or Position | OWNER
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Name | SADRA JAZAYERI
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Credential | M.D.
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Telephone | 602-971-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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