Provider Demographics
NPI:1255378097
Name:SIERRA DERMATOLOGY PC
Entity type:Organization
Organization Name:SIERRA DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARIZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-388-2743
Mailing Address - Street 1:3060 HIGHWAY 180 E
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7703
Mailing Address - Country:US
Mailing Address - Phone:575-388-2743
Mailing Address - Fax:575-388-8885
Practice Address - Street 1:3060 HIGHWAY 180 E
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7703
Practice Address - Country:US
Practice Address - Phone:575-388-2743
Practice Address - Fax:575-388-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00001768Medicaid
NMNMA100002Medicare PIN
NM070001983Medicare PIN