Healthcare Provider Details

I. General information

NPI: 1003373192
Provider Name (Legal Business Name): BRAULIO JOSE CUESTA CAMUNAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE AMERICO MIRANDA HOSPITAL ONCOLOGICO
SAN JUAN PR
00935-0816
US

IV. Provider business mailing address

833 COND LINCOLN PARK, APT 2B
GUAYNABO PR
00969-3365
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-4149
  • Fax:
Mailing address:
  • Phone: 787-241-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number24449
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: