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General NPI Number Information
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NPI Number | 1942199500
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Entity Type | Organization
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Legal Business Name | BILLET DERMATOLOGY INC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 5540 W GLENDALE AVE STE A103
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City | GLENDALE
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State | AZ
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Zip | 85301-2579
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Country | US
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Telephone | 833-224-5538
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Fax | 833-424-5538
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Provider Business Mailing Address
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Address Line | 6710 N 47TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-4121
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Country | US
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Telephone | 833-224-5538
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Fax | 833-424-5538
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ZACHARY CORONADO
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Credential |
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Telephone | 623-521-9113
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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