Provider Demographics
NPI:1982487351
Name:AB DERM LLC
Entity Type:Organization
Organization Name:AB DERM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ARIAS BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-646-1910
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:STE 303 INSTITUTO SAN PABLO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7049
Mailing Address - Country:US
Mailing Address - Phone:787-705-2944
Mailing Address - Fax:787-705-2943
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:STE 303 INSTITUTO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7049
Practice Address - Country:US
Practice Address - Phone:787-705-2944
Practice Address - Fax:787-705-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty