NPI 1104452804 · live from the CMS NPI Registry
Divine Dermatology And Surgical Institute, PLLC
Dermatology in Loveland, CO. National Provider Identifier 1104452804, active.
NPI record
| NPI | 1104452804 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 1327 Eagle Dr, Loveland, CO 80537 |
| Practice phone | 970-286-2668 |
| Enumerated | March 14, 2020 |
| Last updated | March 14, 2020 |
| Authorized official | Jennifer Divine, Owner |
| Other names | Divine Dermatology And Surgical Institute |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.