Provider Demographics
NPI:1952421471
Name:DERMACENTRAL, CSP
Entity Type:Organization
Organization Name:DERMACENTRAL, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-286-7421
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0864
Mailing Address - Country:US
Mailing Address - Phone:787-286-7421
Mailing Address - Fax:
Practice Address - Street 1:LAS CATALINAS MALL OFC CENTER
Practice Address - Street 2:SUITE 209
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-286-7421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083609Medicare ID - Type Unspecified