Healthcare Provider Details

I. General information

NPI: 1427947209
Provider Name (Legal Business Name): DERMATECH MOBILE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28059 US HIGHWAY 19 N STE 205
CLEARWATER FL
33761-2620
US

IV. Provider business mailing address

28059 US HIGHWAY 19 N STE 205
CLEARWATER FL
33761-2620
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-7501
  • Fax:
Mailing address:
  • Phone: 310-547-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER FOX
Title or Position: MANAGER
Credential:
Phone: 310-547-7501