1194704882 NPI number — CENTRO DERMATOLOGICO SAN PABLO, PSC

Table of content: (NPI 1194704882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194704882 NPI number — CENTRO DERMATOLOGICO SAN PABLO, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DERMATOLOGICO SAN PABLO, PSC
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:
1194704882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVENIDA 90
Provider Second Line Business Mailing Address:
PMB SUITE 126
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-1200
Provider Business Mailing Address Fax Number:
787-740-1200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE SANTA CRUZ #68 TORRE SAN PABLO
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-1200
Provider Business Practice Location Address Fax Number:
787-740-1200
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ-ESPINOSA
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-740-0564

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)





Copyright © 2007-2025 www.npivalidator.com