North Valley Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

16095 Issued in AZ

Legal business name

NORTH VALLEY DERMATOLOGY LLC

Practice address

14155 N 83Rd Ave
Suite 110
Peoria, AZ 85381-5639

Phone

(623) 215-0911

Fax

(623) 215-0912

NPI assigned

Dec 15, 2005

Last updated

Sep 12, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary F Fredenberg, MDNPI 1134140999

Title

Owner

Phone

(623) 215-0911

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary F Fredenberg, MD

  • Dermatology Physician
  • Peoria, AZ
  • NPI 1134140999
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1184600884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14155 N 83RD AVE",
            "address_2": "SUITE 110",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815639",
            "telephone_number": "623-215-0911",
            "fax_number": "623-215-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14155 N 83RD AVE",
            "address_2": "SUITE 110",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815639",
            "telephone_number": "623-215-0911",
            "fax_number": "623-215-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH VALLEY DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "FREDENBERG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-215-0911",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "16095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.