Provider Demographics
NPI:1184842536
Name:DERMA-CARE AESTHETIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DERMA-CARE AESTHETIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-2030
Mailing Address - Street 1:1575 AVE MUNOZ RIVERA
Mailing Address - Street 2:PMB 316
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-844-2030
Mailing Address - Fax:787-844-2030
Practice Address - Street 1:1575 AVE MUNOZ RIVERA
Practice Address - Street 2:PMB 316
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0211
Practice Address - Country:US
Practice Address - Phone:787-844-2030
Practice Address - Fax:787-844-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI50345Medicare UPIN
PR0021223Medicare Oscar/Certification