1548501950 NPI number — ADVANCEDERMATOLOGY AND SKIN CANCER CENTER, PSC

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 1548501950 NPI number — ADVANCEDERMATOLOGY AND SKIN CANCER CENTER, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCEDERMATOLOGY AND SKIN CANCER CENTER, 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:
6
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:
1548501950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 CALLE KINGS CT APT 904
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00911-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-945-6546
Provider Business Mailing Address Fax Number:
787-945-6571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 AVE JOSE DE DIEGO SAN JUAN HEALTH CENTRE
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-945-6546
Provider Business Practice Location Address Fax Number:
787-945-6571
Provider Enumeration Date:
03/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTIN
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-945-6546

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  16842 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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