Healthcare Provider Details

I. General information

NPI: 1548197791
Provider Name (Legal Business Name): DERMATOLOGY AND COSMETICS INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E HALLANDALE BEACH BLVD STE 302
HALLANDALE BEACH FL
33009-3771
US

IV. Provider business mailing address

1945 S OCEAN DR APT 1912
HALLANDALE BEACH FL
33009-6089
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-8258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARINA OMAROV
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 786-252-8258