Provider Demographics
NPI:1285850230
Name:DERMASURGERY, PSC
Entity Type:Organization
Organization Name:DERMASURGERY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUIZ SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-641-9585
Mailing Address - Street 1:1845 CARR #2 STE 907
Mailing Address - Street 2:BAYAMON MEDICAL PLAZA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7206
Mailing Address - Country:US
Mailing Address - Phone:787-641-9585
Mailing Address - Fax:787-641-9586
Practice Address - Street 1:1845 CARR #2 STE 907
Practice Address - Street 2:BAYAMON MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7206
Practice Address - Country:US
Practice Address - Phone:787-641-9585
Practice Address - Fax:787-641-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12825261QH0100X
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG84826Medicare UPIN