Organization
DERMATOLOGY AND MOHS SURGERY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERTO LUIS DAVILA - DE PEDRO M.D. (DERMATOLOGIST AND MOHS SURGEON)
(787) 764-6611
Entity
Organization
Contact information
Practice address
525 FD ROOSEVELT AVENUE SUITE 712, SAN JUAN, PR 00918
(787) 764-6611
(787) 957-3110
Mailing address
PO BOX 191259, 525 FD ROOSEVELT AVENUE SUITE 712, SAN JUAN, PR 00919
(787) 764-6611
(787) 957-3110
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27404
MEDICAL CARD SYSTEM
PR
Enumeration date
06/24/2019
Last updated
04/13/2022
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