Provider Demographics
NPI:1417496688
Name:DERMACLINIC LLC
Entity Type:Organization
Organization Name:DERMACLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-539-4905
Mailing Address - Street 1:175 SW 7TH ST
Mailing Address - Street 2:SUITE 1708
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2992
Mailing Address - Country:US
Mailing Address - Phone:786-539-4905
Mailing Address - Fax:786-539-4905
Practice Address - Street 1:175 SW 7TH ST
Practice Address - Street 2:SUITE 1708
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2992
Practice Address - Country:US
Practice Address - Phone:786-539-4905
Practice Address - Fax:786-539-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28187261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28187OtherDBPR