Provider Demographics
NPI:1518010479
Name:CAPARRA DERMATOLOGY CENTER
Entity Type:Organization
Organization Name:CAPARRA DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-781-8999
Mailing Address - Street 1:PO BOX 360867
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0867
Mailing Address - Country:US
Mailing Address - Phone:787-781-8999
Mailing Address - Fax:
Practice Address - Street 1:107 GONZALEZ GIUSTI AVE.
Practice Address - Street 2:CAPARRA GALLERY, SUITE 309
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-781-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-5045OtherTRIPLE-S
PR8-5045OtherTRIPLE-S