Provider Demographics
NPI:1942238258
Name:CHILDREN'S SKIN CENTER PA
Entity Type:Organization
Organization Name:CHILDREN'S SKIN CENTER PA
Other - Org Name:GABLES SKIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-668-5518
Mailing Address - Street 1:PO BOX 144341
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4341
Mailing Address - Country:US
Mailing Address - Phone:305-668-5518
Mailing Address - Fax:305-668-5579
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-668-5518
Practice Address - Fax:305-668-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56604207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261982200Medicaid
FL261982200Medicaid