Provider Demographics
NPI:1538592886
Name:CENTRO DERMATOLOGICO DEL ESTE DRA ELENA NOGALES PSC
Entity type:Organization
Organization Name:CENTRO DERMATOLOGICO DEL ESTE DRA ELENA NOGALES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:NOGALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-860-4500
Mailing Address - Street 1:TORRE MEDICA HIAM SAN PABLO
Mailing Address - Street 2:OFC 402
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-4500
Mailing Address - Fax:787-863-7400
Practice Address - Street 1:AVE GENERAL VALERO # 410
Practice Address - Street 2:TORRE MEDICA HIMA SAN PABLO OFC 402
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3949
Practice Address - Country:US
Practice Address - Phone:787-860-4500
Practice Address - Fax:787-863-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty