MEDICARE: SKINPROS INTERNATIONAL PLLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1710523618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKINPROS INTERNATIONAL PLLC

Provider Business Mailing Address
First Line	:	1675 GAR HWY
Second Line	:
City	:	SWANSEA
State	:	MA
Zip	:	02777-3901
Country	:	US
Telephone Number	:	508-490-5959
Fax Number	:	508-490-5960

Provider Business Practice Location Address
First Line	:	1675 GAR HWY
Second Line	:
City	:	SWANSEA
State	:	MA
Zip	:	02777-3901
Country	:	US
Telephone Number	:	508-490-5959
Fax Number	:	508-490-5960

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ANTONIO CRUZ
Credential	:	MD
Telephone Number	:	401-272-2724

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	12/12/2019

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