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Organization

EPIPHANY DERMATOLOGY OF ARIZONA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GHEORGHE PUSTA (CEO)
(512) 628-0465
Entity
Organization

Contact information

Practice address
7767 W DEER VALLEY RD, SUITE 140, PEORIA, AZ 85382-2103
(623) 487-3003
(623) 487-0952
Mailing address
7300 RANCH RD. 2222, BLDG 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 628-0468

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Enumeration date
08/19/2006
Last updated
12/07/2023
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