Omni Dermatology Olive LLC

NPI #1669914172 in Glendale, Arizona

Provider Information

NPI Number: 1669914172
Entity Type: Organization
Organization Name: Omni Dermatology Olive LLC
Primary Specialty: Specialist
Enumeration Date: Nov 15, 2016
Last Updated: Nov 15, 2016

Practice Location

Address: 5700 W OLIVE AVE
Address 2: STE 101
City: Glendale
State: Arizona
ZIP Code: 85302-3147
Phone: (602) 559-5470

Authorized Official

Name: DR. ANDREW JOSEPH RACETTE, D.O.
Title: PRESIDENT
Phone: (602) 954-3919

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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