Omni Dermatology Estrella LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OMNI DERMATOLOGY ESTRELLA LLC

Practice address

9305 W Thomas Rd
Ste 350
Phoenix, AZ 85037-3328

Phone

(623) 478-8000

Fax

(623) 478-8003

NPI assigned

Nov 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Joseph Racette, D.O.

Title

President

Phone

(602) 954-3919

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479168000000",
    "number": "1225570732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 E INDIAN SCHOOL RD",
            "address_2": "STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185500",
            "telephone_number": "602-954-3919",
            "fax_number": "602-954-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9305 W THOMAS RD",
            "address_2": "STE 350",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850373328",
            "telephone_number": "623-478-8000",
            "fax_number": "623-478-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DERMATOLOGY ESTRELLA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-11-15",
        "status": "A",
        "authorized_official_last_name": "RACETTE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-954-3919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.