Provider Demographics
NPI:1063838118
Name:DE JESUS, AUGUSTO (PHD)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTO
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P5 SANTA JUANA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2047
Mailing Address - Country:US
Mailing Address - Phone:787-746-6667
Mailing Address - Fax:787-744-3469
Practice Address - Street 1:9 MUNOZ RIVERA ST
Practice Address - Street 2:2B
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-6667
Practice Address - Fax:787-744-3469
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical