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General NPI Number Information
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NPI Number | 1366379992
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Entity Type | Organization
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Legal Business Name | JC MEDICAL DERM LLC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 725 AVE WEST MAIN STE 1100A
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City | BAYAMON
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State | PR
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Zip | 00961-4638
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Country | US
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Telephone | 787-780-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 725 AVE WEST MAIN STE 40
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City | BAYAMON
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State | PR
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Zip | 00961-4635
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Country | US
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Telephone | 787-780-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE M CUESTA CAMUNAS
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Credential |
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Telephone | 787-780-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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