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General NPI Number Information
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NPI Number | 1275206872
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Entity Type | Organization
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Legal Business Name | DERMWATTS
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | C8 AVE. GAUTIER BENITEZ CONSOLIDATED MALL
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City | CAGUAS
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State | PR
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Zip | 00726
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Country | US
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Telephone | 787-772-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 AVE ASHFORD APT 2102
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City | SAN JUAN
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State | PR
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Zip | 00907-1368
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Country | US
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Telephone | 787-455-7822
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | ERIKA T WATTS OQUENDO
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Credential | MD
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Telephone | 787-455-7822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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