Healthcare Provider Details

I. General information

NPI: 1366379992
Provider Name (Legal Business Name): JC MEDICAL DERM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AVE WEST MAIN STE 1100A
BAYAMON PR
00961-4638
US

IV. Provider business mailing address

725 AVE WEST MAIN STE 40
BAYAMON PR
00961-4635
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-4300
  • Fax:
Mailing address:
  • Phone: 787-780-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE M CUESTA CAMUNAS
Title or Position: PRESIDENT
Credential:
Phone: 787-780-4300