Organization
TWIN CITIES DERMATOPATHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DINA VALLADARES (SENIOR DIRECTOR)
(954) 803-9405
Entity
Organization
Contact information
Practice address
9900 13TH AVENUE NORTH, SUITE 2A, PLYMOUTH, MN 55441-5035
(763) 525-0363
(763) 525-0369
Mailing address
9900 13TH AVE N STE 2A, PLYMOUTH, MN 55441-5069
(763) 525-0363
(763) 525-0369
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
1279
MN
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24D0651415
CLIA
—
05
—
32939100
—
WI
05
—
732527400
—
MN
Enumeration date
05/24/2005
Last updated
04/07/2026
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