Provider Demographics
NPI:1083755425
Name:SANTOS ELOSEGUI, JESUS MANUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MANUEL
Last Name:SANTOS ELOSEGUI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0384
Mailing Address - Country:US
Mailing Address - Phone:787-491-5050
Mailing Address - Fax:787-737-4659
Practice Address - Street 1:CARR 189 KM 7.8
Practice Address - Street 2:BO MAMEY 1
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-491-5050
Practice Address - Fax:787-737-4659
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13402207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20257OtherSSS
H81136Medicare UPIN
PR20257OtherSSS