Provider Demographics
NPI:1407167596
Name:AHWATUKEE SKIN & LASER LLC
Entity Type:Organization
Organization Name:AHWATUKEE SKIN & LASER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-704-7546
Mailing Address - Street 1:4425 E AGAVE RD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-0619
Mailing Address - Country:US
Mailing Address - Phone:480-704-7546
Mailing Address - Fax:480-704-7549
Practice Address - Street 1:4425 E AGAVE RD
Practice Address - Street 2:SUITE 148
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0619
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:2010-06-23
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15963207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty