Provider Demographics
NPI:1053749879
Name:DERMATOLOGY & CUTANEOUS SURGERY INSTITUTE (DCSI), PA
Entity type:Organization
Organization Name:DERMATOLOGY & CUTANEOUS SURGERY INSTITUTE (DCSI), PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-246-1791
Mailing Address - Street 1:12788 FOREST HILL BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4703
Mailing Address - Country:US
Mailing Address - Phone:561-246-1791
Mailing Address - Fax:561-469-6456
Practice Address - Street 1:12788 FOREST HILL BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4703
Practice Address - Country:US
Practice Address - Phone:561-246-1791
Practice Address - Fax:614-696-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14JU9OtherBLUE CROSS