Healthcare Provider Details

I. General information

NPI: 1457267106
Provider Name (Legal Business Name): SR DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE F.D. ROOSEVELT SUITE 409
SAN JUAN PR
00918-8081
US

IV. Provider business mailing address

PO BOX 1300
GUAYAMA PR
00785-1300
US

V. Phone/Fax

Practice location:
  • Phone: 787-473-0073
  • Fax:
Mailing address:
  • Phone: 787-473-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH ISABEL RIVERA DE PENA
Title or Position: OWNER
Credential: MD
Phone: 787-314-7201