| NPI | 1245953215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD TELLERIA Practice Manager 407-260-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2024-05-17 |