Provider Demographics
NPI:1780489526
Name:DESERT OASIS DERMATOLOGY PLLC
Entity type:Organization
Organization Name:DESERT OASIS DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-418-3314
Mailing Address - Street 1:13835 N TATUM BLVD STE 9-268
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5590
Mailing Address - Country:US
Mailing Address - Phone:480-418-3314
Mailing Address - Fax:480-923-6586
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:480-418-3314
Practice Address - Fax:480-923-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty