Provider Demographics
NPI:1841370160
Name:DESERT DERMATOLOGY OF YUMA INC
Entity type:Organization
Organization Name:DESERT DERMATOLOGY OF YUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SLOMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-344-5771
Mailing Address - Street 1:2741 S 8TH AVE
Mailing Address - Street 2:A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-344-5771
Mailing Address - Fax:928-344-6064
Practice Address - Street 1:2741 S 8TH AVE
Practice Address - Street 2:A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-5771
Practice Address - Fax:928-344-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74382Medicare ID - Type Unspecified