Provider Demographics
NPI:1508473620
Name:DE JESUS, MARIA ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:DE JESUS
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 1:881 CALLE MANUEL GUERRA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2533
Mailing Address - Country:US
Mailing Address - Phone:787-750-6525
Mailing Address - Fax:
Practice Address - Street 1:AVE ROBERTO CLEMENTE BLOQUE 124
Practice Address - Street 2:NO. 8 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-0098
Practice Address - Country:US
Practice Address - Phone:407-732-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22007208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice