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General NPI Number Information
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NPI Number | 1427221605
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Entity Type | Organization
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Legal Business Name | ACUTE DERMATOLOGY CLINIC PA
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 9400 GLADIOLUS DR SUITE 320
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City | FORT MYERS
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State | FL
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Zip | 33908-6699
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Country | US
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Telephone | 239-482-7546
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 101295
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City | CAPE CORAL
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State | FL
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Zip | 33910-1295
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Country | US
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Telephone | 239-482-7546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAU PAULINA VU
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Credential |
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Telephone | 239-482-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OS9425
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License Number State | FL
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