Healthcare Provider Details

I. General information

NPI: 1942855150
Provider Name (Legal Business Name): INTERNATIONAL DERMATOLOGY RESEARCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8370 W FLAGLER ST STE 200
MIAMI FL
33144-2038
US

IV. Provider business mailing address

8370 W FLAGLER ST STE 200
MIAMI FL
33144-2038
US

V. Phone/Fax

Practice location:
  • Phone: 786-294-3835
  • Fax: 305-225-0450
Mailing address:
  • Phone: 786-294-3835
  • Fax: 305-225-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SILVIA A TRINIDAD
Title or Position: OWNER, CEO, CFO
Credential:
Phone: 305-225-0400