Provider Demographics
NPI:1225647647
Name:MARVICT DERMATOLOGY AND PREVENTIVE CARE INC
Entity Type:Organization
Organization Name:MARVICT DERMATOLOGY AND PREVENTIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDOLIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-458-7046
Mailing Address - Street 1:2596 W 73RD PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6503
Mailing Address - Country:US
Mailing Address - Phone:786-458-7046
Mailing Address - Fax:
Practice Address - Street 1:2097 WEST 76 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3825
Practice Address - Country:US
Practice Address - Phone:786-606-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty