REJUVA DERMATOLOGY & VEIN, PLLC (NPI# 1477107407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477107407 |
| Entity Type | Organization |
| Organization Name | REJUVA DERMATOLOGY & VEIN, PLLC |
| Practice Address |
3016 Communications Pkwy Ste 100 Plano TX 75093-8906 |
| Mailing Address |
1576 Bella Cruz Dr # 264 Lady Lake FL 32159-8969 |
| Practice Telephone | 2145163824 |
| Mailing Telephone | 6466470411 |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | DR. GOLTA RASOULI (PHYSICIAN) |
| Authorized Official Telephone | 6466470411 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 202K00000X | Phlebology | Allopathic & Osteopathic Physicians | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Advanced Medical Associates | Other Name - Individual/Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1186 W Pioneer Pkwy, Arlington, TX 760136367 | 8177044223 | 8179843970 |
| Street Address |
3016 COMMUNICATIONS PKWY STE 100 |
| City | PLANO |
| State | TX |
| Zip Code | 75093-8906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154569820 | Ragan Lynn Hurt | Physician Assistant | 3016 Communications Pkwy Ste 100, Plano, TX 75093-8906 | 2009-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235789041 | Mapleshade Surgery Center, LLC | Clinic/Center | 960 Ohio Dr, Plano, TX 75093 | 2019-09-13 |
| 1003461468 | Psyclear, LLC | Psychologist | 5055 West Park Boulevard, Suite 400, Plano, TX 75093 | 2019-08-02 |
| 1962981795 | Ep Anesthesia Pllc | Anesthesiology | 4100 Mapleshade Ln, Plano, TX 75093 | 2018-08-13 |
| 1669973939 | Eva Walekhwa | Registered Nurse | 6000 Ohio Drive, Apt 1027, Plano, TX 75093 | 2018-02-22 |
| 1437657624 | Advanced Spine Center | Orthopaedic Surgery | 1705 Ohio Drive, Suite 300, Plano, TX 75093 | 2018-01-23 |
| 1184139974 | Erica Cherese Carey | Nurse Practitioner | 1100 Allied Drive, Plano, TX 75093 | 2017-12-04 |
| 1457865578 | Norma Vigilant | Specialist/Technologist, Other | 4909 West Park Blvd, Plaza Park Salons, Plano, TX 75093 | 2017-11-28 |
| 1891214011 | Americare Rx Pharmacy Inc | Pharmacy | 4010 W. 15th St., Ste 60, Plano, TX 75093 | 2017-09-19 |
| 1760912554 | Baylor Surgicare At Baylor Plano, LLC | Clinic/Center | 4825 Alliance, Sute 300, Plano, TX 75093 | 2017-06-14 |
| 1881133262 | Dr.seshagiri Rao | Preferred Provider Organization | 3016 Communications Pkwy, Ste 100, Plano, TX 75093 | 2017-02-17 |
| Find all providers in zip 75093 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780879346 | Eric Stephen Hollabaugh, M.d., Pa | Dermatology | 6100 Windhaven Pkwy Ste 208, Plano, TX 75093-8046 | 2007-09-07 |
| 1265978084 | Michael J Wells Mdpa | Dermatology | 6100 Windhaven Pkwy, Plano, TX 75093-8046 | 2017-01-18 |
| 1962898312 | Pooyan Rohani | Dermatology | 6000 W Spring Creek Pkwy Ste 200, Plano, TX 75024-3617 | 2015-04-13 |
| 1114363488 | Gunjan M. Modi, M.d., P.a. | Dermatology | 6100 Windhaven Pkwy, Plano, TX 75093-8046 | 2013-05-14 |
| 1356589204 | Gunjan M Modi | Dermatology | 6100 Windhaven Pkwy, Plano, TX 75093-8046 | 2009-01-30 |
| 1346425915 | Edward Lansing Parry Md Pa | Dermatology | 6100 Windhaven Pkwy, Plano, TX 75093-8046 | 2008-01-02 |
| 1194813543 | Paul T Martinelli | Dermatology | 4716 Alliance Blvd, Suite 150, Plano, TX 75093-5371 | 2006-10-11 |
| 1497749824 | Eric Stephen Hollabaugh | Dermatology | 6100 Windhaven Pkwy, Plano, TX 75093-8046 | 2005-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649800848 | Skin Cancer Dermatology, Pllc | Dermatology | 3327 Research Plz Ste 414, San Antonio, TX 78235-5159 | 2020-01-16 |
| 1598302721 | Austin Skin Pllc | Dermatology | 1501 Dorothy Nichols Ln # B, Smithville, TX 78957-1725 | 2019-12-06 |
| 1154717726 | Joshua Lee Owen | Dermatology | 2632 Broadway, Suite 300 South, San Antonio, TX 78215-7821 | 2015-04-10 |
| 1043615263 | Epiphany Dermatology Pa | Dermatology | 7106 Sanger Avenue, Waco, TX 76712-3928 | 2014-10-30 |
| 1255745915 | Leon Chen | Dermatology | 6655 Travis St Ste 650, Houston, TX 77030-1316 | 2014-06-19 |
| 1750624391 | Houston Skin Cancer Associates, Pllc | Dermatology | 1401 Binz Street, Suite 200, Houston, TX 77004 | 2013-04-02 |
| 1457695413 | Oliver Street 5.01(a) Inc. | Dermatology | 5310 Harvest Hill Rd Ste 290, Dallas, TX 75230-5826 | 2012-11-15 |
| 1427330588 | Michael A. Sorace Md Pa | Dermatology | 7950 Floyd Curl Dr Ste 505, Medical Center Tower 1, San Antonio, TX 78229-3924 | 2011-09-15 |
| 1811229180 | Skin Surgery Center, Pa | Dermatology | 6208 Colleyville Blvd, Suite 100, Colleyville, TX 76034-6223 | 2010-02-11 |
| 1265614168 | Michael Sorace | Dermatology | 745 W San Antonio Ave, Suite 100, Boerne, TX 78006-3213 | 2007-12-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.