1922477421 NPI number — DERMATOLOGY SCIENCE AND AESTHETICS PSC

Table of content: (NPI 1922477421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922477421 NPI number — DERMATOLOGY SCIENCE AND AESTHETICS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY SCIENCE AND AESTHETICS 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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922477421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
387 VIA VERSALLES
Provider Second Line Business Mailing Address:
VILLAS REALES
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-365-0315
Provider Business Mailing Address Fax Number:
787-802-2626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 891 KM 13 PUEBLO
Provider Second Line Business Practice Location Address:
PLAZA DEL CARMEN SUITE 308
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-365-0315
Provider Business Practice Location Address Fax Number:
787-802-2626
Provider Enumeration Date:
09/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROSADO
Authorized Official First Name:
AMARYLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-365-0315

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  15519 , 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)

  • Identifier: 15519 . This is a "STATE LISCENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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