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General NPI Number Information
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NPI Number | 1528487683
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Entity Type | Organization
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Legal Business Name | COASTAL DERM & COSMETIC CENTER, INC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1539 ATWOOD AVE SUITE 301
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City | JOHNSTON
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State | RI
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Zip | 02919-3262
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Country | US
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Telephone | 401-490-4515
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Fax | 401-490-4516
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Provider Business Mailing Address
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Address Line | 1539 ATWOOD AVE SUITE 301
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City | JOHNSTON
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State | RI
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Zip | 02919-3262
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Country | US
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Telephone | 401-490-4515
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Fax | 401-490-4516
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Authorized Official
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Title or Position | OWNER
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Name | HUA ZHOU
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Credential |
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Telephone | 401-490-4515
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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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