Healthcare Provider Details

I. General information

NPI: 1558007260
Provider Name (Legal Business Name): JEAN CARLOS TAMAYO ACOSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE SANTA CRUZ
BAYAMON PR
00961-6906
US

IV. Provider business mailing address

1041 SE 25TH AVE
HOMESTEAD FL
33035-2191
US

V. Phone/Fax

Practice location:
  • Phone: 787-235-8492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1765
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number24593
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: