MEDICARE: DERMASURGERY, PSC

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	261QH0100X	Health Service Clinic/Center	12825	PR
2	261QH0100X	Health Service Clinic/Center		PR

General Provider Information

NPI Number	:	1285850230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMASURGERY, PSC

Provider Business Mailing Address
First Line	:	1845 CARR #2 STE 907
Second Line	:	BAYAMON MEDICAL PLAZA
City	:	BAYAMON
State	:	PR
Zip	:	00959-7206
Country	:	US
Telephone Number	:	787-641-9585
Fax Number	:	787-641-9586

Provider Business Practice Location Address
First Line	:	1845 CARR #2 STE 907
Second Line	:	BAYAMON MEDICAL PLAZA
City	:	BAYAMON
State	:	PR
Zip	:	00959-7206
Country	:	US
Telephone Number	:	787-641-9585
Fax Number	:	787-641-9586

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HIRAM A. RUIZ SANTIAGO
Credential	:	M.D.
Telephone Number	:	787-641-9585

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	05/27/2015

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Directions to “DERMASURGERY, PSC ” Practice Location

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