Healthcare Provider Details

I. General information

NPI: 1861106528
Provider Name (Legal Business Name): WESTSIDE DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE DEL RIO N
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1299
MAYAGUEZ PR
00681-1299
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVARO JULIAN RAMOS-RODRIGUEZ
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 787-827-9393