MEDICARE: DERMATOLOGY AND COSMETICS INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1548197791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY AND COSMETICS INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1945 S OCEAN DR APT 1912
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 E HALLANDALE BEACH BLVD STE 302
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3771
Country	:	US
Telephone Number	:	786-252-8258
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MARINA OMAROV
Credential	:	PA
Telephone Number	:	786-252-8258

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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