Organization
CORAL REEF DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE MOORE PA (OWNER/MANAGER)
(772) 882-5612
Entity
Organization
Contact information
Practice address
160 NW CENTRAL PARK PLAZA, SUITE 103, PORT ST LUCIE, FL 34986
(772) 882-5612
Mailing address
160 NW CENTRAL PARK PLAZA SUITE 103, PORT ST LUCIE, FL 34986
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
02/28/2022
Last updated
02/28/2022
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