Provider Demographics
NPI:1568416790
Name:RCDC OF MESA PLC
Entity Type:Organization
Organization Name:RCDC OF MESA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-8484
Mailing Address - Street 1:2158 N GILBERT RD
Mailing Address - Street 2:SUITE 121A
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2109
Mailing Address - Country:US
Mailing Address - Phone:480-461-0150
Mailing Address - Fax:
Practice Address - Street 1:2158 N GILBERT RD
Practice Address - Street 2:SUITE 121A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2109
Practice Address - Country:US
Practice Address - Phone:480-461-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty