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General NPI Number Information
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NPI Number | 1982225496
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Entity Type | Organization
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Legal Business Name | ARTIUS DERMATOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 5757 PACIFIC AVE STE 228
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City | STOCKTON
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State | CA
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Zip | 95207-5159
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Country | US
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Telephone | 209-490-5050
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Fax | 209-779-6211
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Provider Business Mailing Address
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Address Line | PO BOX 101868
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City | PASADENA
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State | CA
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Zip | 91189-0055
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Country | US
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Telephone | 956-803-0711
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Fax | 956-803-0711
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Authorized Official
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Title or Position | CFO
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Name | RONALD MISTAK
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Credential |
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Telephone | 361-248-1505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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