Provider Demographics
NPI:1083023493
Name:DERMATOLOGY SOLUTIONS LLC
Entity Type:Organization
Organization Name:DERMATOLOGY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:XUAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-832-2213
Mailing Address - Street 1:4915 E BASELINE RD
Mailing Address - Street 2:BUILDING 9 SUITE 124
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2965
Mailing Address - Country:US
Mailing Address - Phone:480-832-2213
Mailing Address - Fax:480-832-2077
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:BUILDING 9 SUITE 124
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-832-2213
Practice Address - Fax:480-832-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID