Provider Demographics
NPI:1922477421
Name:DERMATOLOGY SCIENCE AND AESTHETICS PSC
Entity Type:Organization
Organization Name:DERMATOLOGY SCIENCE AND AESTHETICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARYLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-365-0315
Mailing Address - Street 1:387 VIA VERSALLES
Mailing Address - Street 2:VILLAS REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5341
Mailing Address - Country:US
Mailing Address - Phone:787-365-0315
Mailing Address - Fax:787-802-2626
Practice Address - Street 1:CARR 891 KM 13 PUEBLO
Practice Address - Street 2:PLAZA DEL CARMEN SUITE 308
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0009
Practice Address - Country:US
Practice Address - Phone:787-365-0315
Practice Address - Fax:787-802-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15519261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15519OtherSTATE LISCENSE