Provider Demographics
NPI:1528075645
Name:SUNSET DERMATOLOGY SKIN, LASER & VEIN CENTER, P.A.
Entity type:Organization
Organization Name:SUNSET DERMATOLOGY SKIN, LASER & VEIN CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ-QUINTAIROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-669-2799
Mailing Address - Street 1:6310 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4823
Mailing Address - Country:US
Mailing Address - Phone:305-669-2799
Mailing Address - Fax:305-662-5895
Practice Address - Street 1:6310 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4823
Practice Address - Country:US
Practice Address - Phone:305-669-2799
Practice Address - Fax:305-662-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59703207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ346Medicare PIN
FLF92489Medicare UPIN
FL26274CMedicare ID - Type Unspecified