Provider Demographics
NPI:1780229625
Name:OASIS DERMATOLOGY PC
Entity Type:Organization
Organization Name:OASIS DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEYO-DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-589-2039
Mailing Address - Street 1:4729 E SUNRISE DR # 207
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4534
Mailing Address - Country:US
Mailing Address - Phone:520-589-2039
Mailing Address - Fax:
Practice Address - Street 1:1055 N LA CANADA DR STE 101
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3700
Practice Address - Country:US
Practice Address - Phone:520-589-2039
Practice Address - Fax:520-230-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00000OtherMEDICAID