Provider Demographics
NPI:1366670069
Name:DE JESUS-BURGOS, ARACELI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARACELI
Middle Name:
Last Name:DE JESUS-BURGOS
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:STREET 111 KM 12.6
Mailing Address - Street 2:BO. CAPA BOSQUES
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-949-3652
Mailing Address - Fax:
Practice Address - Street 1:STREET 111, KM 12.6
Practice Address - Street 2:BO CAPA BOSQUES
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-949-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17639OtherPUERTO RICO PHYSICIAN LICENCE NUMBER