Ncderm LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

19082 Issued in PR

Legal business name

NCDERM LLC

Practice address

500 Degetau Avenue
Hima Plaza I, Suite 513
Caguas, PR 00725

Phone

(787) 626-3431

Fax

(787) 626-5163

NPI assigned

Aug 23, 2016

Organization subpart

No

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

Authorized official

Name

Nicole Sofia Carvajal Diaz

Title

President

Phone

(787) 360-6112

Specialties & licenses 1

Addresses

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.

• Nicole Sofia Carvajal, MD

  • Dermatology Physician
  • Caguas, PR
  • NPI 1952664807
  Medicare reassignment NPD
• Rachelle E. Seijo, M.D.

  • Dermatology Physician
  • Caguas, PR
  • NPI 1548417454
  NPD (past)

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1386199032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 AVE LUIS VIGOREAUX",
            "address_2": "PMB 322",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009662715",
            "telephone_number": "787-626-3431",
            "fax_number": "787-626-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DEGETAU AVENUE",
            "address_2": "HIMA PLAZA I, SUITE 513",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "00725",
            "telephone_number": "787-626-3431",
            "fax_number": "787-626-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NCDERM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-23",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL DIAZ",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "SOFIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-360-6112"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "PR",
            "license": "19082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria B Navarro, MA
• Suheily Navedo Resto, MD
• Raul Alejandro Nazario Martinez
• Michelle I Nazario
• Yamil Nazario, M.S,H,
• Modesto Nchez de Leon, PSICOLOGO MA
• NCR Chiropractic LLC
• Nefro, PSC
• Kamila Negron de Jesus
• Ivelisse Negron, PSY. D.

• Medical Specialty Clinic/Center in Caguas, PR
• Providers in Caguas, PR by specialty
• Medical Specialty Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; 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.