Healthcare Provider Details

I. General information

NPI: 1578476586
Provider Name (Legal Business Name): MCM DERM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO SUITE 403 TORRE SAN FRANCISCO
SAN JUAN PR
00923-3155
US

IV. Provider business mailing address

369 CALLE DE DIEGO SUITE 403 TORRE SAN FRANCISCO
SAN JUAN PR
00923-3155
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-3400
  • Fax:
Mailing address:
  • Phone: 787-998-3400
  • 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: MARIANA CRUZ MANZANO
Title or Position: DRA
Credential: MD
Phone: 787-998-3400