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Contact Information

CORAL REEF DERMATOLOGY LLC
160 NW CENTRAL PARK PLAZA
SUITE 103
PORT SAINT LUCIE, FL34986
 Phone: 772-882-5612
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for CORAL REEF DERMATOLOGY LLC

NPI Number 1487300521
LBN Legal business name CORAL REEF DERMATOLOGY LLC
Authorized official CHARLENE MOORE - (OWNER/MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/28/2022
Last updated 02/28/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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