1801417316 NPI number — ARTIUS DERMATOLOGY ASSOCIATES PC

Table of content: WILLIAM CHARLES SANDERSON LCSW (NPI 1871574723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801417316 NPI number — ARTIUS DERMATOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTIUS DERMATOLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801417316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91189-0055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-803-0748
Provider Business Mailing Address Fax Number:
956-803-0711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
296 COTTAGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95336-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-624-7006
Provider Business Practice Location Address Fax Number:
209-554-4601
Provider Enumeration Date:
05/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MISTAK
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
361-248-1505

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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