Provider Demographics
NPI:1063297182
Name:PABON DERMATOLOGY, LLC
Entity type:Organization
Organization Name:PABON DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-415-1545
Mailing Address - Street 1:PO BOX 192382
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-415-1545
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 415
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5026
Practice Address - Country:US
Practice Address - Phone:787-763-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty