Healthcare Provider Details

I. General information

NPI: 1073628491
Provider Name (Legal Business Name): JERRY CHARLES CHARNECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CALLE MUNOZ MARIN
HUMACAO PR
00791-3646
US

IV. Provider business mailing address

63 AVE MUNOZ MARIN
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-7900
  • Fax: 787-850-7900
Mailing address:
  • Phone: 787-850-7900
  • Fax: 787-850-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4249
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: