1326745571 NPI number — DERMATOLOGIA BORINQUEN LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326745571 NPI number — DERMATOLOGIA BORINQUEN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGIA BORINQUEN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326745571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-6106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-586-2208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 AVENIDA GAUTIER BENITEZ
Provider Second Line Business Practice Location Address:
CONSOLIDATED MEDICAL PLAZA 405A
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-346-3376
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ SANTIAGO
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DERMATOLOGIST
Authorized Official Telephone Number:
787-246-3376

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)