Healthcare Provider Details

I. General information

NPI: 1861856551
Provider Name (Legal Business Name): DEYSON LORENZO-RIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 AVE 65 INFANTERIA STE 303
CAROLINA PR
00985-5672
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-4304
  • Fax:
Mailing address:
  • Phone: 787-758-5500
  • Fax: 787-767-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021312
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021312
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD223992
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: