Organization
DESERT MOUNTAIN SKIN CANCER SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE MARIE REISINGER M.D. (PHYSICIAN)
(505) 980-8738
Entity
Organization
Contact information
Practice address
2019 GALISTEO STREET, SUITE N-9B, SANTA FE, NM 87505
(505) 980-8738
(505) 404-8423
Mailing address
PO BOX 604, PLACITAS, NM 87043-0604
(505) 980-8738
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD2011-0829
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003975699
—
NM
Enumeration date
11/04/2016
Last updated
01/18/2017
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