Provider Demographics
NPI:1013034172
Name:JILOCA DEJESUS JILOCA MDPA
Entity Type:Organization
Organization Name:JILOCA DEJESUS JILOCA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:JILOCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-4569
Mailing Address - Street 1:105 A FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973
Mailing Address - Country:US
Mailing Address - Phone:302-629-4569
Mailing Address - Fax:302-628-4669
Practice Address - Street 1:105 A FRONT STREET
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973
Practice Address - Country:US
Practice Address - Phone:302-629-4569
Practice Address - Fax:302-628-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty