Organization
OASIS DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA A LEYO-DUPONT MD (PRESIDENT)
(520) 589-2039
Entity
Organization
Contact information
Practice address
1055 N LA CANADA DR STE 101, GREEN VALLEY, AZ 85614-3700
(520) 589-2039
(520) 230-4544
Mailing address
4729 E SUNRISE DR # 207, TUCSON, AZ 85718-4534
(520) 589-2039
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
MEDICAID
AZ
Enumeration date
11/14/2019
Last updated
07/02/2020
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