Healthcare Provider Details

I. General information

NPI: 1467124727
Provider Name (Legal Business Name): SKINPROS NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
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:
Mailing address:
  • Phone: 401-272-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONIO P. CRUZ
Title or Position: OWNER
Credential:
Phone: 401-272-2724