Organization
OMNI DERMATOLOGY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW J RACETTE D.O. (PRESIDENT)
(602) 369-3634
Entity
Organization
Contact information
Practice address
11851 N 51ST AVE STE E130, GLENDALE, AZ 85304-2843
(480) 954-3919
(480) 954-3670
Mailing address
11851 N 51ST AVE STE E130, GLENDALE, AZ 85304-2843
(236) 299-9540
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4311
AZ
Other
Enumeration date
04/30/2008
Last updated
04/03/2024
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