Provider Demographics
NPI:1629120605
Name:DE JESUS-ORPI, JAVIER MIGUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:MIGUEL
Last Name:DE JESUS-ORPI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PADRE RIVERA AVE.
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-850-2640
Mailing Address - Fax:787-268-3583
Practice Address - Street 1:52 PADRE RIVERA AVE.
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-2640
Practice Address - Fax:787-268-3583
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0036213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT86327Medicare UPIN
PR48052Medicare ID - Type Unspecified