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Organization
PALADIN DERMATOLOGY LLC
Active
Organization
PALADIN DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOE HERNANDEZ (MANAGING OFFICIAL)
(804) 648-4802
Entity
Organization
Contact information
Practice address
44 A& B MEDICAL PARK BLVD, PETERSBURG, VA 23805
(804) 648-4802
Mailing address
1801 LIBBIE AVE STE 204, RICHMOND, VA 23226-1836
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024164803
VA
Other
Enumeration date
05/27/2015
Last updated
10/27/2015
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