Provider Demographics
NPI:1326745571
Name:DERMATOLOGIA BORINQUEN LLC
Entity type:Organization
Organization Name:DERMATOLOGIA BORINQUEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:787-246-3376
Mailing Address - Street 1:PO BOX 6106
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6106
Mailing Address - Country:US
Mailing Address - Phone:787-246-3376
Mailing Address - Fax:939-355-0306
Practice Address - Street 1:201 AVENIDA GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MEDICAL PLAZA (OFFICE 405A)
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-246-3376
Practice Address - Fax:939-355-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty