Healthcare Provider Details

I. General information

NPI: 1679488688
Provider Name (Legal Business Name): DERM 360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 N KENDALL DR STE 200
MIAMI FL
33156-8423
US

IV. Provider business mailing address

7700 N KENDALL DR STE 200
MIAMI FL
33156-8423
US

V. Phone/Fax

Practice location:
  • Phone: 786-707-4888
  • Fax: 786-520-2579
Mailing address:
  • Phone: 786-707-4888
  • Fax: 786-520-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MERCEDES E GONZALEZ
Title or Position: OWNER/MANAGING MEMBER
Credential: MD
Phone: 917-309-3214