NPIMap

Organization Active NPI

Rejuva Dermatology & Vein Center, LLC

Doing business as Dermatology Associates

  • Dermatology Physician
  • Venice, FL
National Provider Identifier
1316522691
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
REJUVA DERMATOLOGY & VEIN CENTER, LLC
Doing business as
Dermatology Associates
Practice address
395 Commercial CT Ste C
Venice, FL 34292-1651
Phone
(941) 529-0070
Fax
(941) 529-0539
NPI assigned
Mar 17, 2021
Last updated
Sep 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Golta Rasouli, MDNPI 1154765667
Title
Co-Presendent
Phone
(941) 529-0070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
MOHS-Micrographic Surgery Physician 207ND0101X
Internal Medicine Physician 207R00000X
Phlebology Physician 202K00000X

Addresses

Primary practice location

395 Commercial CT Ste C
Venice, FL 34292-1651

Mailing address

2389 E Venice Ave Unit 510
Venice, FL 34292-2465
Phone (941) 529-0070

Other names 1

  • Dermatology Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210514002045 FL Part B Supplier - Clinic/Group Practice 3173932548 Receives reassigned benefits from 11 practitioners
Practice locations: Venice, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2235709Rejuva Dermatology & Vein Center PLLC395 Commercial Court Unit C, Venice, FL 34292ComplianceApr 17, 2028

National Provider Directory

National Provider Directory

Locations

1611 53rd Ave W
Bradenton, FL 34207
Phone (941) 753-9599

395 Commercial Ct
Ste C
Venice, FL 34292
Phone (941) 529-0070

395 Commercial Ct
Ste D
Venice, FL 34292

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790640000000",
    "number": "1316522691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2389 E VENICE AVE UNIT 510",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922465",
            "telephone_number": "941-529-0070",
            "fax_number": "941-529-0539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 COMMERCIAL CT STE C",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342921651",
            "telephone_number": "941-529-0070",
            "fax_number": "941-529-0539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVA DERMATOLOGY & VEIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A",
        "authorized_official_last_name": "RASOULI",
        "authorized_official_first_name": "GOLTA",
        "authorized_official_title_or_position": "CO-PRESENDENT",
        "authorized_official_telephone_number": "941-529-0070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.