Provider Demographics
NPI:1790550812
Name:MOBILE DERMATOLOGY HEALTH LLC
Entity Type:Organization
Organization Name:MOBILE DERMATOLOGY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:ANASTASIO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:551-574-3296
Mailing Address - Street 1:11954 NARCOOSSEE RD # 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6998
Mailing Address - Country:US
Mailing Address - Phone:551-574-3296
Mailing Address - Fax:
Practice Address - Street 1:9067 LOWER CARREL CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-3834
Practice Address - Country:US
Practice Address - Phone:551-574-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty