Organization
DERMATOLOGY CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STELLA D CALOBRISI M.D. (DIRECTOR)
(561) 393-0300
Entity
Organization
Contact information
Practice address
880 NW 13TH ST, SUITE 3B, BOCA RATON, FL 33486-2342
(561) 393-0300
(561) 393-0048
Mailing address
880 NW 13TH ST, SUITE 3B, BOCA RATON, FL 33486-2342
(561) 393-0300
(561) 393-0048
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
78997
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115370
BLUE SHIELD PENN NUMBER
PA
01
—
1891717898
NPI INDIVIDUAL NUMBER
FL
01
—
49480
FL BLUE SHIELD NUMBER
FL
01
—
49480Z
MEDICARE INDIVIDUAL
FL
01
—
78997
FLORIDA LICENSE NUMBER
FL
Enumeration date
12/26/2006
Last updated
11/23/2010
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