NPIMap

Organization Active NPI

Alta Dermatology Group LTD

  • Dermatology Physician
  • Mesa, AZ
National Provider Identifier
1780801506
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ALTA DERMATOLOGY GROUP LTD
Practice address
130 S 63Rd St
BLDG 3 Ste 114
Mesa, AZ 85206-1620
Phone
(480) 981-2888
Fax
(480) 654-0599
NPI assigned
Apr 20, 2007
Last updated
Oct 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

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

Authorized official

Name
Rebecca Castillo
Title
Office Manager
Phone
(480) 981-2888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

130 S 63Rd St
BLDG 3 Ste 114
Mesa, AZ 85206-1620

Mailing address

130 S 63Rd St
BLDG 3 Ste 114
Mesa, AZ 85206-1620
Phone (480) 981-2888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330001528 AZ Part B Supplier - Clinic/Group Practice 4587656723 Receives reassigned benefits from 8 practitioners
Practice locations: Mesa, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0529113Alta Dermatology Group, LTD Dba Alta Dermatology130 S 63Rd St, BLDG 3, Ste 114, Mesa, AZ 85206ComplianceJan 17, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1780801506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 S 63RD ST",
            "address_2": "BLDG 3 STE 114",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061620",
            "telephone_number": "480-981-2888",
            "fax_number": "480-654-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S 63RD ST",
            "address_2": "BLDG 3 STE 114",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061620",
            "telephone_number": "480-981-2888",
            "fax_number": "480-654-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA DERMATOLOGY GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-981-2888"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.