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General NPI Number Information
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NPI Number | 1780964460
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Entity Type | Organization
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Legal Business Name | GALT DERMATOLOGY & CONCIERGE MEDICINE PA
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 800 E BROWARD BLVD SUITE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2008
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Country | US
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Telephone | 954-463-5406
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Fax | 954-522-2456
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Provider Business Mailing Address
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Address Line | 800 E BROWARD BLVD SUITE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2008
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Country | US
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Telephone | 954-463-5406
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIGUEL VILLACORTA
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Credential | DO
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Telephone | 954-463-5406
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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 | ME36538
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License Number State | FL
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