Organization
PUERTO RICO SKIN & LASER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS NOELANI E GONZALEZ MD, (OWNER)
(787) 473-0073
Entity
Organization
Contact information
Practice address
525 AVE FD ROOSEVELT STE 409, SAN JUAN, PR 00918-8081
(787) 473-0073
Mailing address
120 AVE CARLOS CHARDON STE 133, SAN JUAN, PR 00918-1721
(787) 473-0073
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1187256-0010
REGISTRO DE COMERCIANTE
PR
01
—
446563
CERTIFICATE OF ORGANIZATION
PR
Enumeration date
08/19/2021
Last updated
06/26/2023
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