Provider Demographics
NPI:1376188383
Name:ENCHANTRESS DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:ENCHANTRESS DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZUZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GASCON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-346-3629
Mailing Address - Street 1:241 NW 119 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1329
Mailing Address - Country:US
Mailing Address - Phone:786-346-3629
Mailing Address - Fax:
Practice Address - Street 1:241 NW 119 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1329
Practice Address - Country:US
Practice Address - Phone:786-346-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty