| NPI | 1164391959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN ACOSTA CFO & Executive VP Of Ops 725-207-9887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2025-10-31 |
| Last Update Date | 2025-10-31 |