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General NPI Number Information
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NPI Number | 1528075645
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Entity Type | Organization
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Legal Business Name | SUNSET DERMATOLOGY SKIN, LASER & VEIN CENTER, P.A.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 6310 SUNSET DR
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4823
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Country | US
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Telephone | 305-669-2799
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Fax | 305-662-5895
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Provider Business Mailing Address
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Address Line | 6310 SUNSET DR
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4823
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Country | US
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Telephone | 305-669-2799
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Fax | 305-662-5895
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ILEANA R PEREZ-QUINTAIROS
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Credential | MD
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Telephone | 305-669-2799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | ME59703
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License Number State | FL
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