Provider Demographics
NPI:1528042603
Name:BARBOSA, JESUS MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MARIA
Last Name:BARBOSA
Suffix:
Gender:M
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:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0697
Mailing Address - Country:US
Mailing Address - Phone:787-257-3666
Mailing Address - Fax:787-701-0859
Practice Address - Street 1:C/11 BLQ. 33 #8
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-762-3625
Practice Address - Fax:787-701-0859
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist