Healthcare Provider Details

I. General information

NPI: 1689370199
Provider Name (Legal Business Name): TOTAL VEIN AND SKIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 LINTON BLVD STE 203B
DELRAY BEACH FL
33445-6615
US

IV. Provider business mailing address

10383 HAGEN RANCH RD STE 100
BOYNTON BEACH FL
33437-3782
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-5341
  • Fax:
Mailing address:
  • Phone: 561-739-5252
  • Fax: 561-739-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MATTHEW BERLIN
Title or Position: OWNER
Credential: MD
Phone: 561-739-5252