1. Home
  2. Directory
  3. Arizona
  4. Tempe
  5. Specialist
  6. NPI Profile

OMNI DERMATOLOGY TEMPE LLC
NPI 1639611130
Specialist in Tempe, AZ

Active since November 15, 2016CLIA 03D2101446 · Certificate of Compliance
4515 S MCCLINTOCK DR, STE 101, TEMPE, AZ 85282(602) 559-5470(602) 559-5471 Get Directions Write a Review

NPPES record last updated: November 15, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Omni Dermatology Tempe Llc NPPES

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

OMNI DERMATOLOGY TEMPE LLC (NPI 1639611130) is a healthcare organization registered as a specialist in Tempe, Arizona and active in the NPI registry since November 2016. The organization holds a CLIA Certificate of Compliance certificate valid through April 22, 2028 and lists Andrew Joseph Racette, President, as its authorized official.

NPPES Registry Identity

NPI1639611130
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameOMNI DERMATOLOGY TEMPE LLC
Location Address4515 S MCCLINTOCK DR, STE 101Tempe, AZ 85282-7376
Mailing Address4840 E Indian School Rd, Ste 102Phoenix, AZ 85018-5500 · (602) 559-9961 · Fax (602) 954-3670
Phone(602) 559-5470
Fax(602) 559-5471
Organization SubpartNo
Authorized OfficialAndrew Joseph RacettePresident · (602) 559-9961
Enumeration DateNovember 15, 2016
✔ NPI 1639611130 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4515 S MCCLINTOCK DR, Tempe, AZ 85282
Open in Google Maps ↗

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 Compliance 03D2101446

Omni Dermatology, Inc · Tempe, AZ
Active · expires Apr 22, 2028
CLIA Number03D2101446
Laboratory TypePhysician Office
Certificate Effective DateApril 23, 2026
Certificate Expiration DateApril 22, 2028
Laboratory DirectorAndrew J. Racette
Laboratory Phone(602) 559-5470
Laboratory LocationOmni Dermatology, Inc4515 S Mcclintock Dr Ste 101, Tempe, AZ 85282
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 20

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

REX ALAN COBLE
Behavior Technician
4515 S MCCLINTOCK DR
TEMPE, AZ 85282
Maricopa County (704) 890-4379
EAST VALLEY PRIMARY CARE PHYSICIANS
Clinic/Center (Primary Care)
4515 S MCCLINTOCK DR, STE 100
TEMPE, AZ 85282
Maricopa County (480) 820-1133
REGINA M WRIGHT MD
Family Medicine
4515 S MCCLINTOCK DR, STE 100
TEMPE, AZ 85282
Maricopa County (480) 820-1133
NOVACARE OUTPATIENT REHABILITATION WEST INC
Clinic/Center (Physical Therapy)
4515 S MCCLINTOCK DR, STE 110
TEMPE, AZ 85282
Maricopa County (480) 839-2196
NAJIYYAH JAMILAH BELLMON-COOPER
Clinic/Center (Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF))
4515 S MCCLINTOCK DR
TEMPE, AZ 85282
Maricopa County (737) 742-1867
TYLER JOHNSON
Behavior Technician
4515 S MCCLINTOCK DR
TEMPE, AZ 85282
Maricopa County (602) 390-2350
COMPUDIAGNOSTICS INC
Radiologic Technologist (Sonography)
4515 S MCCLINTOCK DR, SUITE 115
TEMPE, AZ 85282
Maricopa County (480) 998-9226
MS. LESLIE SUE INNIS PHYSICAL THERAPIST
Physical Therapist
4515 S MCCLINTOCK DR, SUITE#118
TEMPE, AZ 85282
Maricopa County (505) 270-6545

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Omni Dermatology Tempe LLC's NPI number?

The NPI number for Omni Dermatology Tempe LLC is 1639611130. It was assigned to this organization in the NPPES registry on November 15, 2016.

Where is Omni Dermatology Tempe LLC located?

Omni Dermatology Tempe LLC is located at 4515 S Mcclintock Dr Ste 101, Tempe, AZ 85282. The listed phone number is (602) 559-5470.

What is Omni Dermatology Tempe LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Omni Dermatology Tempe LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 03D2101446) is associated with this NPI, valid through April 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Omni Dermatology Tempe LLC was last updated on November 15, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.