MEDICARE: DERMA MEDICAL OF LAREDO, 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	:	1598600249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMA MEDICAL OF LAREDO, LLC

Provider Business Mailing Address
First Line	:	7616 ROCIO DR STE 102
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6676
Country	:	US
Telephone Number	:	956-645-9569
Fax Number	:

Provider Business Practice Location Address
First Line	:	7616 ROCIO DR STE 102
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6676
Country	:	US
Telephone Number	:	956-645-9569
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KASSANDRA MONTALVO-CEDILLO
Credential	:	MSN, FNP-C
Telephone Number	:	956-764-0865

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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