Provider Demographics
NPI:1376704734
Name:SOUTH MIAMI DERMATOLOGY PA
Entity Type:Organization
Organization Name:SOUTH MIAMI DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:RODRIGUEZ-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-970-9038
Mailing Address - Street 1:6351 SUNSET DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4842
Mailing Address - Country:US
Mailing Address - Phone:305-970-9038
Mailing Address - Fax:305-663-1156
Practice Address - Street 1:6351 SUNSET DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4842
Practice Address - Country:US
Practice Address - Phone:305-970-9038
Practice Address - Fax:305-663-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95752207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty