Healthcare Provider Details

I. General information

NPI: 1437517802
Provider Name (Legal Business Name): TOTAL VEIN AND SKIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10383 HAGEN RANCH ROAD STE 100
BOYNTON BEACH FL
33437-3732
US

IV. Provider business mailing address

10383 HAGEN RANCH RD STE. 100
BOYNTON BEACH FL
33437-3732
US

V. Phone/Fax

Practice location:
  • Phone: 561-739-5252
  • Fax:
Mailing address:
  • Phone: 561-739-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY BERLIN
Title or Position: MANAGER
Credential:
Phone: 561-739-5252