| NPI | 1427040799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA J HERNANDEZ Credentialing Specialist 813-493-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 2004000225) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2023-07-03 |