Provider Demographics
NPI:1215121827
Name:DERMA MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DERMA MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:URSA
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-759-5122
Mailing Address - Street 1:AVE PONCE DE LEON 735
Mailing Address - Street 2:TORRE AUXILIO MUTUO SUITE 519
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-759-5122
Mailing Address - Fax:787-753-4797
Practice Address - Street 1:AVE PONCE DE LEON 735
Practice Address - Street 2:TORRE AUXILIO MUTUO SUITE 519
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-759-5122
Practice Address - Fax:787-753-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty