Provider Demographics
NPI:1760522114
Name:PL DERMA PSC
Entity Type:Organization
Organization Name:PL DERMA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLON DE JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD,, FAAD
Authorized Official - Phone:787-763-1612
Mailing Address - Street 1:PO BOX 22678
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-2678
Mailing Address - Country:US
Mailing Address - Phone:787-763-1612
Mailing Address - Fax:787-753-7615
Practice Address - Street 1:6 CALLE JOSE FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4404
Practice Address - Country:US
Practice Address - Phone:787-763-1612
Practice Address - Fax:787-753-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty