SAGEBRUSH DERMATOLOGY PLLC
NPI 1174274435
Dermatology in Mesa, AZ

Active since January 18, 2022CLIA 03D2266070 · Waiver
5432 E SOUTHERN AVE STE 101B, MESA, AZ 85206(480) 681-3376(480) 681-3372 Get Directions Write a Review

NPPES record last updated: March 3, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 3, 2022, Jan 20, 2022 (2 updates tracked since 2022).

About Sagebrush Dermatology Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAGEBRUSH DERMATOLOGY PLLC (NPI 1174274435) is a healthcare organization registered as a dermatology in Mesa, Arizona and active in the NPI registry since January 2022. The organization holds a CLIA Waiver certificate valid through December 5, 2026 and lists Chao Li, Owner, as its authorized official.

NPPES Registry Identity

NPI1174274435
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSAGEBRUSH DERMATOLOGY PLLC
Location Address5432 E SOUTHERN AVE STE 101BMesa, AZ 85206-2772
Mailing Address5432 E Southern Ave Ste 101bMesa, AZ 85206-2772
Fax(480) 681-3372
Organization SubpartNo
Authorized OfficialChao LiOwner · (480) 681-3376
Enumeration DateJanuary 18, 2022
Last NPPES UpdateMarch 3, 20222 updates tracked since enumeration
NPPES CertifiedMarch 3, 2022
NPI 1174274435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

5432 E SOUTHERN AVE STE 101B, Mesa, AZ 85206

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2266070

Sagebrush Dermatology · Mesa, AZ
Active · expires Dec 5, 2026
CLIA Number03D2266070
Laboratory TypePhysician Office
Certificate Effective DateDecember 6, 2024
Certificate Expiration DateDecember 5, 2026
Laboratory DirectorChao Li
Laboratory Phone(480) 681-3376
Laboratory LocationSagebrush Dermatology5432 E Southern Ave Ste 101b, Mesa, AZ 85206
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
5432 E SOUTHERN AVE STE 101B
MESA, AZ 85206
Dermatology
5432 E SOUTHERN AVE STE 101B
MESA, AZ 85206
Podiatrist (Foot & Ankle Surgery)
5432 E SOUTHERN AVE STE 101B
MESA, AZ 85206
Podiatrist (Foot & Ankle Surgery)
5432 E SOUTHERN AVE STE 101B
MESA, AZ 85206

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1174274435, enumerated as an "organization" on January 18, 2022.

The provider is located at 5432 E SOUTHERN AVE STE 101B MESA, AZ 85206 and the phone number is (480) 681-3376.

Dermatology with taxonomy code 207N00000X.