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DESERT MOUNTAIN SKIN CANCER SURGERY LLC NPI 1104378314


NPI Information

NPI: 1104378314
Provider Name: DESERT MOUNTAIN SKIN CANCER SURGERY, LLC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 32D2122507

Address:
2019 GALISTEO STREET
SUITE N-9B
SANTA FE, NM
ZIP 87505
Phone: (505) 980-8738
Get Directions

DESERT MOUNTAIN SKIN CANCER SURGERY, LLC is a mohs-micrographic surgery dermatology in Santa Fe, NM. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. DESERT MOUNTAIN SKIN CANCER SURGERY, LLC NPI is 1104378314. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2019 GALISTEO STREET
SUITE N-9B
SANTA FE, NM
ZIP 87505
Phone: (505) 980-8738
Fax: (505) 404-8423

The provider's authorized official is Diane Marie Reisinger .
The authorized official title is Physician and has the following contact phone number (505) 980-8738.

The CLIA number assigned to this NPI record is 32D2122507 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/4/2016 and was last updated on 1/18/2017.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic SurgeryMD2011-0829NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11003975699MEDICARE PINNEW MEXICO
21003975699MEDICARE UPINNEW MEXICO
31003975699MEDICAIDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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