Provider Demographics
NPI:1003486036
Name:JB DERMATOLOGY LLC
Entity Type:Organization
Organization Name:JB DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BARRERA LLAURADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-957-5540
Mailing Address - Street 1:PO BOX 6775
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 GRAND BLVD LOS PRADOS # Z-5
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9507
Practice Address - Country:US
Practice Address - Phone:787-746-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty