Provider Demographics
NPI:1558459024
Name:GOMEZ DE JESUS, MARIA ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANGELICA
Last Name:GOMEZ 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:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741-0024
Mailing Address - Country:US
Mailing Address - Phone:787-405-0030
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA BOULEVARD DEL RIO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1400
Practice Address - Fax:787-852-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95512083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine