Healthcare Provider Details

I. General information

NPI: 1881966901
Provider Name (Legal Business Name): SKINPROS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2012
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

IV. Provider business mailing address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2724
  • Fax: 401-272-2784
Mailing address:
  • Phone: 401-272-2724
  • Fax: 401-272-2784

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. ANTONIO PAULINO CRUZ
Title or Position: OWNER/ MANAGER
Credential: MD
Phone: 401-243-3675