1265518161 NPI number — MOUNTAINVIEW DERMATOLOGY, LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265518161 NPI number — MOUNTAINVIEW DERMATOLOGY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAINVIEW DERMATOLOGY, LTD
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:
1265518161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2375 N WYATT DR
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-2152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-881-8161
Provider Business Mailing Address Fax Number:
520-881-8163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2375 N WYATT DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-881-8161
Provider Business Practice Location Address Fax Number:
520-881-8163
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EPSTEIN
Authorized Official First Name:
MARC
Authorized Official Middle Name:
IRWIN
Authorized Official Title or Position:
PRESIDENT/DERMATOLOGIST
Authorized Official Telephone Number:
520-881-8161

Provider Taxonomy Codes

  • Taxonomy code: 207ND0900X , with the licence number:  2881 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com