NPIMap

Organization Active NPI

MB Dermatology, PSC

  • Dermatology Physician
  • Guaynabo, PR
National Provider Identifier
1386903573
Registry record updated May 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
17621 Issued in PR
Legal business name
MB DERMATOLOGY, PSC
Practice address
Centro Internacional de Mercadeo, Tower 1, Suite 304
Road 165 PR-28
Guaynabo, PR 00968
Phone
(787) 705-8887
Fax
(787) 705-8886
NPI assigned
May 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2012

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

Authorized official

Name
Dr. Mayra C Beauchamp, MD
Title
Dermatologist/Owner
Phone
(787) 630-1369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 17621 PR Primary

Addresses

Primary practice location

Centro Internacional de Mercadeo, Tower 1, Suite 304
Road 165 PR-28
Guaynabo, PR 00968

Mailing address

PMB 705, 89 de Diego Ave.
Suite 105
San Juan, PR 00927-6320
Phone (787) 705-8887

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1386903573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB 705, 89 DE DIEGO AVE.",
            "address_2": "SUITE 105",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009276320",
            "telephone_number": "787-705-8887",
            "fax_number": "787-705-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CENTRO INTERNACIONAL DE MERCADEO, TOWER 1, SUITE 304",
            "address_2": "ROAD 165 PR-28",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "00968",
            "telephone_number": "787-705-8887",
            "fax_number": "787-705-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MB DERMATOLOGY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAMP",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DERMATOLOGIST/OWNER",
        "authorized_official_telephone_number": "787-630-1369",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PR",
            "license": "17621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guaynabo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.