Provider Demographics
NPI:1205373255
Name:DERMATOLOGY AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIALET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-2544
Mailing Address - Street 1:9150 ESTATE THOMAS
Mailing Address - Street 2:STE. 106
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2611
Mailing Address - Country:US
Mailing Address - Phone:340-776-2544
Mailing Address - Fax:
Practice Address - Street 1:9150 ESTATE THOMAS
Practice Address - Street 2:STE. 106
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2611
Practice Address - Country:US
Practice Address - Phone:340-776-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI461207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty