Healthcare Provider Details

I. General information

NPI: 1821679929
Provider Name (Legal Business Name): SIMONA B BARTOS DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN STREET STE I
HOLLYWOOD FL
33021-3416
US

IV. Provider business mailing address

4700 SHERIDAN STREET STE I
HOLLYWOOD FL
33021-3416
US

V. Phone/Fax

Practice location:
  • Phone: 954-937-2294
  • Fax:
Mailing address:
  • Phone: 954-937-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SIMONA B BARTOS
Title or Position: PRESIDENT
Credential: DO
Phone: 954-516-0722