Organization
TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER, PLLC
Active
Organization
TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN R PORTELA DO (PRESIDENT)
(208) 351-8088
Entity
Organization
Contact information
Practice address
2535 E FAIRVIEW AVE, MERIDIAN, ID 83642-8072
(208) 519-4333
(208) 205-9134
Mailing address
2535 E FAIRVIEW AVE, MERIDIAN, ID 83642
(208) 351-8088
(208) 519-4333
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
O-1052
ID
Other
Enumeration date
12/26/2017
Last updated
04/08/2024
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