OMNI DERMATOLOGY TEMPE LLC NPI 1639611130

NPI Information

OMNI DERMATOLOGY TEMPE LLC is a specialist in Tempe, AZ. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. OMNI DERMATOLOGY TEMPE LLC NPI is 1639611130. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4515 S MCCLINTOCK DR
STE 101
TEMPE, AZ
ZIP 85282-376
Phone: (602) 559-5470
Fax: (602) 559-5471

The provider's authorized official is Andrew Joseph Racette .
The authorized official title is President and has the following contact phone number (602) 559-9961.

The CLIA number assigned to this NPI record is 03D2101446 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/15/2016 and was last updated on 11/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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