Provider Demographics
NPI:1992105126
Name:ARIZONA SKIN INSTITUTE, PC
Entity type:Organization
Organization Name:ARIZONA SKIN INSTITUTE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-225-7546
Mailing Address - Street 1:11340 W BELL RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9335
Mailing Address - Country:US
Mailing Address - Phone:623-225-7546
Mailing Address - Fax:623-225-7548
Practice Address - Street 1:11340 W BELL RD STE 127
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9335
Practice Address - Country:US
Practice Address - Phone:623-225-7546
Practice Address - Fax:623-225-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty