Provider Demographics
NPI:1194704882
Name:CENTRO DERMATOLOGICO SAN PABLO, PSC
Entity type:Organization
Organization Name:CENTRO DERMATOLOGICO SAN PABLO, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTIZ-ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAD
Authorized Official - Phone:787-740-0564
Mailing Address - Street 1:AVENIDA 90
Mailing Address - Street 2:PMB SUITE 126
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-798-1200
Mailing Address - Fax:787-740-1200
Practice Address - Street 1:CALLE SANTA CRUZ #68 TORRE SAN PABLO
Practice Address - Street 2:SUITE 306
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-1200
Practice Address - Fax:787-740-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty