Provider Demographics
NPI:1235566993
Name:DERMATOLOGY MEDICAL CENTER OF SOUTH TEXAS, PA
Entity Type:Organization
Organization Name:DERMATOLOGY MEDICAL CENTER OF SOUTH TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDIL
Authorized Official - Middle Name:ALDARONDO
Authorized Official - Last Name:ANTONINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAD
Authorized Official - Phone:956-729-7700
Mailing Address - Street 1:2344 LAGUNA DEL MAR CT STE 101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0059
Mailing Address - Country:US
Mailing Address - Phone:956-729-7700
Mailing Address - Fax:
Practice Address - Street 1:2344 LAGUNA DEL MAR CT STE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-729-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty