Provider Demographics
NPI:1528185931
Name:DERMASTHETICS NORTH CLINIC
Entity type:Organization
Organization Name:DERMASTHETICS NORTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIO-GESTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-2233
Mailing Address - Street 1:HOSP DOCTOR CENTER
Mailing Address - Street 2:TORRE MEDICA 1 DR. PEDRO BLANCO LUGO STE 208
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSP DOCTOR CENTER
Practice Address - Street 2:TORRE MEDICA 1 DR. PEDRO BLANCO LUGO STE 208
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:178-785-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEMPLOYER IDENTIFICATION