Dermatology and Mohs Surgery Associates LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AND MOHS SURGERY ASSOCIATES LLC

Practice address

525 FD Roosevelt Avenue Suite 712
San Juan, PR 00918

Phone

(787) 764-6611

Fax

(787) 957-3110

NPI assigned

Jun 24, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roberto Luis Davila - de Pedro, M.D.NPI 1538154315

Title

Dermatologist and Mohs Surgeon

Phone

(787) 764-6611

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roberto Luis Davila-Depedro, MD

  • Dermatology Physician
  • Hato Rey, PR
  • NPI 1538154315
  Medicare reassignment NPD Authorized official
• Kyrmarie M Davila, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Mayaguez, PR
  • NPI 1679854954
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1124689831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191259",
            "address_2": "525 FD ROOSEVELT AVENUE SUITE 712",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00919",
            "telephone_number": "787-764-6611",
            "fax_number": "787-957-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 FD ROOSEVELT AVENUE SUITE 712",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-764-6611",
            "fax_number": "787-957-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND MOHS SURGERY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "DAVILA - DE PEDRO",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "DERMATOLOGIST AND MOHS SURGEON",
        "authorized_official_telephone_number": "787-764-6611",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL CARD SYSTEM",
            "identifier": "27404",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.