Provider Demographics
NPI:1346962057
Name:NOPALLI, LLC
Entity Type:Organization
Organization Name:NOPALLI, LLC
Other - Org Name:SAGUARO DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-681-3300
Mailing Address - Street 1:PO BOX 61025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1025
Mailing Address - Country:US
Mailing Address - Phone:480-681-3300
Mailing Address - Fax:480-681-3301
Practice Address - Street 1:4425 E AGAVE RD STE 148
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0623
Practice Address - Country:US
Practice Address - Phone:480-704-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty