Healthcare Provider Details

I. General information

NPI: 1932019296
Provider Name (Legal Business Name): JC PHYSIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE BOULEVARD P-1449 MOB
TOA BAJA PR
00949-3906
US

IV. Provider business mailing address

PASEO LAS VISTAS D88 CALLE 3
SAN JUAN PR
00926-5935
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-0148
  • Fax:
Mailing address:
  • Phone: 787-201-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN C PEREZ
Title or Position: OWN
Credential: MD
Phone: 787-201-8979