Provider Demographics
NPI:1609515147
Name:MSV DERMATOLOGY
Entity Type:Organization
Organization Name:MSV DERMATOLOGY
Other - Org Name:MARELY SANTIAGO VAZQUEZ, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARELY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-237-5414
Mailing Address - Street 1:H20 PLAZA ONCE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1452
Mailing Address - Country:US
Mailing Address - Phone:787-237-5414
Mailing Address - Fax:
Practice Address - Street 1:DERMAGALLERY
Practice Address - Street 2:COND PALMANOVA PLAZA APT C 120
Practice Address - City:PALMAS DEL MAR, HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-718-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPP539Medicaid
PR21880OtherSTATE LIC
PR1144776865Medicaid
PRPP540Medicaid