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General NPI Number Information
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NPI Number | 1922564707
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Entity Type | Organization
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Legal Business Name | MACHUZAK DERMATOLOGY PLLC
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Dates
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Enumeration Date | 02/16/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 3198 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2239
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Country | US
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Telephone | 928-202-4143
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Fax | 928-233-8917
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Provider Business Mailing Address
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Address Line | 3198 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2239
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Country | US
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Telephone | 928-202-4143
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Fax | 928-233-8917
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DEBRA MORELAND
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Credential |
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Telephone | 480-621-2070
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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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