Provider Demographics
NPI:1942626379
Name:ALTA VISTA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:ALTA VISTA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAROLTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-888-6426
Mailing Address - Street 1:206 W COUNTY LINE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2318
Mailing Address - Country:US
Mailing Address - Phone:303-888-6426
Mailing Address - Fax:303-032-1659
Practice Address - Street 1:206 W COUNTY LINE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2318
Practice Address - Country:US
Practice Address - Phone:303-888-6426
Practice Address - Fax:303-032-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB5102OtherPTAN
CO611405201026OtherCCN