Provider Demographics
NPI:1861813156
Name:ALLIANCE DERMATOLOGY & MOHS CENTER, PC
Entity Type:Organization
Organization Name:ALLIANCE DERMATOLOGY & MOHS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-971-0268
Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2238
Mailing Address - Country:US
Mailing Address - Phone:602-971-0268
Mailing Address - Fax:602-971-1156
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2238
Practice Address - Country:US
Practice Address - Phone:602-971-0268
Practice Address - Fax:602-971-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty