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General NPI Number Information
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NPI Number | 1073878286
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Entity Type | Organization
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Legal Business Name | CLEARWATER DERMATOLOGIC & AESTHETIC INSTITUTE PA
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 1801 N. BELCHER ROAD SUITE B
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City | CLEARWATER
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State | FL
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Zip | 33765-1452
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Country | US
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Telephone | 727-669-3676
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Fax | 727-669-3676
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Provider Business Mailing Address
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Address Line | 1801 N. BELCHER ROAD SUITE B
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City | CLEARWATER
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State | FL
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Zip | 33765-1452
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Country | US
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Telephone | 727-669-3676
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Fax | 727-669-3676
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Authorized Official
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Title or Position | OWNER
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Name | MARIA E GARCIA-CARDONA
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Credential | MD
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Telephone | 727-669-3676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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