Provider Demographics
NPI:1083680722
Name:DEJESUS, MARITESS GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARITESS
Middle Name:GARCIA
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-842-4848
Mailing Address - Fax:
Practice Address - Street 1:5950 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:727-842-4848
Practice Address - Fax:727-842-9513
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54869207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051285100Medicaid
F48520Medicare UPIN
FL07900YMedicare PIN
FL051285100Medicaid