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General NPI Number Information
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NPI Number | 1295890853
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CLINIC, PA
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 880 NW 13TH ST SUITE 3B
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City | BOCA RATON
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State | FL
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Zip | 33486-2342
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Country | US
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Telephone | 561-393-0300
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Fax | 561-393-0048
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Provider Business Mailing Address
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Address Line | 880 NW 13TH ST SUITE 3B
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City | BOCA RATON
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State | FL
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Zip | 33486-2342
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Country | US
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Telephone | 561-393-0300
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Fax | 561-393-0048
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. STELLA D CALOBRISI
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Credential | M.D.
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Telephone | 561-393-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 78997
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License Number State | FL
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