Healthcare Provider Details

I. General information

NPI: 1255513628
Provider Name (Legal Business Name): ZENLO DERMATOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 W BROAD ST SUITE R
GLEN ALLEN VA
23060-6709
US

IV. Provider business mailing address

10120 W BROAD ST SUITE R
GLEN ALLEN VA
23060-6709
US

V. Phone/Fax

Practice location:
  • Phone: 804-934-0060
  • Fax: 804-934-0024
Mailing address:
  • Phone: 804-934-0060
  • Fax: 804-934-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0101051656
License Number StateVA

VIII. Authorized Official

Name: DR. KAREN ROYAL LOVE
Title or Position: PRESIDEDNT
Credential:
Phone: 804-934-0060