Healthcare Provider Details

I. General information

NPI: 1639091234
Provider Name (Legal Business Name): DERMALUXE CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 SW 128TH ST STE D4
MIAMI FL
33186-5829
US

IV. Provider business mailing address

13200 SW 128TH ST STE D4
MIAMI FL
33186-5829
US

V. Phone/Fax

Practice location:
  • Phone: 305-994-6419
  • Fax:
Mailing address:
  • Phone: 305-994-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: YENISSET GAZQUEZ PENALVER
Title or Position: OWNER
Credential: RN
Phone: 305-994-6419