Healthcare Provider Details

I. General information

NPI: 1023631090
Provider Name (Legal Business Name): VICMA FLOR ESCALANTE ZERPA PA DERMATOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 S DOUGLAS RD STE 216
CORAL GABLES FL
33134-4620
US

IV. Provider business mailing address

2935 SW 60TH CT
MIAMI FL
33155-4046
US

V. Phone/Fax

Practice location:
  • Phone: 305-610-0585
  • Fax:
Mailing address:
  • Phone: 786-302-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2064-PA
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPACN38
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number14-518
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTPPA669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: