Provider Demographics
NPI:1578995833
Name:DEJESUS, IRIS MINERVA
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MINERVA
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE SAN CRISTOBAL O-24
Mailing Address - Street 2:ALTURAS DE SAN PEDRO
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-404-3944
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN CRISTOBAL O-24
Practice Address - Street 2:ALTURAS DE SAN PEDRO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-404-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37154163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice