Provider Demographics
NPI:1013569888
Name:DE JESUS, KARLA BEATRIZ
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:BEATRIZ
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 COND BALCONES DE MONTE REAL APT 7701
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2402
Mailing Address - Country:US
Mailing Address - Phone:787-587-1015
Mailing Address - Fax:
Practice Address - Street 1:90 COND BALCONES DE MONTE REAL APT 7701
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2402
Practice Address - Country:US
Practice Address - Phone:787-587-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6043103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling