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NPI Code Detail

MEDICARE: RCDC OF MESA PLC

MEDICARE: RCDC OF MESA PLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1568416790
Entity Type Code : Organization
Provider Name (Legal Business Name) : RCDC OF MESA PLC
Provider Business Mailing Address
First Line : 2158 N GILBERT RD
Second Line : SUITE 121A
City : MESA
State : AZ
Zip : 85203-2109
Country : US
Telephone Number : 480-461-0150
Fax Number :
Provider Business Practice Location Address
First Line : 2158 N GILBERT RD
Second Line : SUITE 121A
City : MESA
State : AZ
Zip : 85203-2109
Country : US
Telephone Number : 480-461-0150
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHARLES W LOVE
Credential : MD
Telephone Number : 515-226-8484
Provider Enumeration Date : 05/20/2006
Last Update Date : 03/15/2013

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Directions to “RCDC OF MESA PLC ” Practice Location

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