Provider Demographics
NPI:1164193066
Name:ARC DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:ARC DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-835-2602
Mailing Address - Street 1:4013 LAKE HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-5258
Mailing Address - Country:US
Mailing Address - Phone:863-314-6809
Mailing Address - Fax:
Practice Address - Street 1:219 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2132
Practice Address - Country:US
Practice Address - Phone:863-835-2602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center