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General NPI Number Information
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NPI Number | 1548197791
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND COSMETICS INSTITUTE LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD STE 302
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3771
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Country | US
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Telephone | 786-252-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 S OCEAN DR APT 1912
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6089
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MARINA OMAROV
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Credential | PA
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Telephone | 786-252-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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