MEDICARE: JB DERMATOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1003486036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JB DERMATOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 6775
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-6775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 GRAND BLVD LOS PRADOS # Z-5
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00727-9507
Country	:	US
Telephone Number	:	787-746-3136
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIAN O BARRERA LLAURADOR
Credential	:	MD
Telephone Number	:	787-957-5540

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	09/07/2022

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