Healthcare Provider Details

I. General information

NPI: 1508495003
Provider Name (Legal Business Name): ELITE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CORAL WAY STE 207
CORAL GABLES FL
33134-4924
US

IV. Provider business mailing address

401 CORAL WAY STE 207
CORAL GABLES FL
33134-4924
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-2941
  • Fax:
Mailing address:
  • Phone: 305-445-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIE CAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-971-1210