Provider Demographics
NPI:1205039682
Name:PRESTIGE DERMATOLOGY INC
Entity Type:Organization
Organization Name:PRESTIGE DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTICCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-849-1447
Mailing Address - Street 1:5091 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-849-1447
Mailing Address - Fax:727-849-3208
Practice Address - Street 1:5091 LITTLE ROAD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-849-1447
Practice Address - Fax:727-849-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7718207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty