Healthcare Provider Details

I. General information

NPI: 1417082769
Provider Name (Legal Business Name): SKIN PATH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7641 66TH ST SUITE C
PINELLAS PARK FL
33781-3173
US

IV. Provider business mailing address

10419 CANARY ISLE DR
TAMPA FL
33647-2713
US

V. Phone/Fax

Practice location:
  • Phone: 813-785-7198
  • Fax:
Mailing address:
  • Phone: 813-785-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SETH ROSENTHAL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 813-785-7198