Provider Demographics
NPI:1124007513
Name:GARCIA-DE JESUS, RICARDO LUIS
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:LUIS
Last Name:GARCIA-DE JESUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CALLE SAN JORGE
Mailing Address - Street 2:SUITE #406
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3310
Mailing Address - Country:US
Mailing Address - Phone:787-726-0210
Mailing Address - Fax:787-728-5136
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SUITE #406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-726-0210
Practice Address - Fax:787-728-5136
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138752080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine