Organization
DESERT MOUNTAIN SKIN CANCER SURGERY, LLC
Active
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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