MEDICARE: DERMA-CARE AESTHETIC MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1184842536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMA-CARE AESTHETIC MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1575 AVE MUNOZ RIVERA
Second Line	:	PMB 316
City	:	PONCE
State	:	PR
Zip	:	00717-0211
Country	:	US
Telephone Number	:	787-844-2030
Fax Number	:	787-844-2030

Provider Business Practice Location Address
First Line	:	1575 AVE MUNOZ RIVERA
Second Line	:	PMB 316
City	:	PONCE
State	:	PR
Zip	:	00717-0211
Country	:	US
Telephone Number	:	787-844-2030
Fax Number	:	787-844-2030

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ASHLEY J GARCIA JORGE
Credential	:	M.D.
Telephone Number	:	787-844-2030

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	10/14/2011

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