Provider Demographics
NPI:1285003111
Name:VILLAGE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:VILLAGE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-952-8400
Mailing Address - Street 1:7575 SAN FELIPE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1780
Mailing Address - Country:US
Mailing Address - Phone:713-952-8400
Mailing Address - Fax:713-952-9448
Practice Address - Street 1:7575 SAN FELIPE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1780
Practice Address - Country:US
Practice Address - Phone:713-952-8400
Practice Address - Fax:713-952-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty