| NPI | 1700398096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIGDALIA SANES Credentialing Manager 352-427-3882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2021-10-04 |