Healthcare Provider Details

I. General information

NPI: 1316865975
Provider Name (Legal Business Name): WEST PALM DERMATOLOGY AND SKINCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 S. DIXIE HIGHWAY SUITE 110
WEST PALM BEACH FL
33405
US

IV. Provider business mailing address

PO BOX 9143
MC LEAN VA
22102-0143
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-0777
  • Fax:
Mailing address:
  • Phone: 561-247-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LILY TALAKOUB
Title or Position: OWNER
Credential: MD
Phone: 561-247-0777