Provider Demographics
NPI:1992547616
Name:AZ SKIN CANCER TREATMENT CENTER LLC
Entity type:Organization
Organization Name:AZ SKIN CANCER TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-616-6643
Mailing Address - Street 1:6535 N ARIZONA BILTMORE CIR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8907
Mailing Address - Country:US
Mailing Address - Phone:602-616-6643
Mailing Address - Fax:
Practice Address - Street 1:14545 W GRAND AVE # A-106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7278
Practice Address - Country:US
Practice Address - Phone:602-616-6643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty