Organization
BELLAVISTA DERMATOLOGY GROUP LLC
Active
Other names
Bellavista Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RIGEL MARTINEZ (OWNER)
(904) 297-1415
Entity
Organization
Contact information
Practice address
3636 UNIVERSITY BLVD S, UNIT B2, JACKSONVILLE, FL 32216
(904) 297-1415
Mailing address
3636 UNIVERSITY BLVD S, UNIT B2, JACKSONVILLE, FL 32216
(904) 297-1415
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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