OrganizationActive
Actinodermatology Ltd
NPI 1063695252 · Dermatology Physician · Tempe, AZ
Provider details
- NPI number
- 1063695252
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jerry Ponitch, President(480) 839-1767
- License
- 7979 (AZ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2600 E Southern Ave
#a-2
Tempe, AZ 85282-7610
Phone: (480) 839-1767
Approximate (ZIP-level) locationGet directions
Mailing address
2600 E Southern Ave
Tempe, AZ 85282-7610
Registry dates
- Enumerated
- 2007-12-11
- Last updated
- 2010-04-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.