Organization
DOCTA LLC
Active
Parent organization
CARLOS H NOUSARI PA
Other names
Nousari Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARLOS H NOUSARI PA
Authorized official
JESSICA HEGEDUS (OFFICE MANAGER/BILLING SPECIALIST)
(754) 444-8503
Entity
Organization
Contact information
Practice address
5200 S UNIVERSITY DR STE 102A, DAVIE, FL 33328-5316
(754) 444-8503
(561) 907-4984
Mailing address
5200 S UNIVERSITY DR STE 102A, DAVIE, FL 33328-5316
(754) 444-8503
(561) 907-4984
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477538940
NPPES
—
01
—
ME88101
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
10/08/2018
Last updated
10/08/2018
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