Provider Demographics
NPI:1629471230
Name:NIV, DORENE
Entity Type:Individual
Prefix:
First Name:DORENE
Middle Name:
Last Name:NIV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10433 MILBURN LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4615
Mailing Address - Country:US
Mailing Address - Phone:214-213-2203
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 37TH AVE STE 801
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2751
Practice Address - Country:US
Practice Address - Phone:305-741-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14665207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology