NPIMap

Organization Active NPI

B Derm PSC

  • Medical Specialty Clinic/Center
  • Caguas, PR
National Provider Identifier
1194278689
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
19349 Issued in PR
Legal business name
B DERM PSC
Practice address
Professional Center
#2 Luis Munoz Rivera St. Suite 201
Caguas, PR 00725
Phone
(787) 744-5353
Fax
(787) 961-1189
NPI assigned
Aug 1, 2016
Last updated
Mar 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Nicole M Candelario, MDNPI 1215243829
Title
President
Phone
(787) 744-5353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 19349 PR Primary

Addresses

Primary practice location

Professional Center
#2 Luis Munoz Rivera St. Suite 201
Caguas, PR 00725

Mailing address

P.O. Box 1176
Caguas, PR 00726
Phone (787) 744-5353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190916001058 PR Part B Supplier - Clinic/Group Practice 9133458201 Receives reassigned benefits from 1 practitioner
Practice locations: Caguas, PR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1470009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1194278689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1176",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "00726",
            "telephone_number": "787-744-5353",
            "fax_number": "787-961-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PROFESSIONAL CENTER",
            "address_2": "#2 LUIS MUNOZ RIVERA ST. SUITE 201",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "00725",
            "telephone_number": "787-744-5353",
            "fax_number": "787-961-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B DERM PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-01",
        "last_updated": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "CANDELARIO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-744-5353",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "PR",
            "license": "19349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caguas, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.