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General NPI Number Information
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NPI Number | 1225928641
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Entity Type | Organization
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Legal Business Name | MEDINA GONZALEZ DERMATOLOGY LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | D80 CALLE C
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City | DORADO
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State | PR
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Zip | 00646-2012
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Country | US
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Telephone | 787-400-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 2765 AVE HOSTOS STE 235
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City | MAYAGUEZ
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State | PR
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Zip | 00682-6390
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Country | US
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Telephone | 787-464-2544
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA CRISTINA MEDINA GONZALEZ
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Credential | MD
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Telephone | 787-464-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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