Organization
DERM HAVEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA MOUSSALLY PA-C (OWNER)
(435) 695-8585
Entity
Organization
Contact information
Practice address
352 E RIVERSIDE DR STE A3, ST GEORGE, UT 84790-6759
(435) 695-8585
(435) 900-1015
Mailing address
782 S RIVER RD STE 101, ST GEORGE, UT 84790-5716
(435) 695-8585
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
05/19/2022
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