Provider Demographics
NPI:1508495003
Name:ELITE DERMATOLOGY
Entity Type:Organization
Organization Name:ELITE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-971-1210
Mailing Address - Street 1:401 CORAL WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4924
Mailing Address - Country:US
Mailing Address - Phone:305-445-2941
Mailing Address - Fax:
Practice Address - Street 1:401 CORAL WAY STE 207
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4924
Practice Address - Country:US
Practice Address - Phone:305-445-2941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty