Provider Demographics
NPI:1366216632
Name:INSTITUTO DERMATOLOGICO DEL PLATA LLC
Entity type:Organization
Organization Name:INSTITUTO DERMATOLOGICO DEL PLATA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RODRIGUEZ-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-336-9019
Mailing Address - Street 1:PO BOX 371867
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1867
Mailing Address - Country:US
Mailing Address - Phone:939-336-9019
Mailing Address - Fax:939-336-9007
Practice Address - Street 1:174 CALLE LUIS BARRERAS S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4615
Practice Address - Country:US
Practice Address - Phone:939-336-9010
Practice Address - Fax:939-336-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty