Provider Demographics
NPI:1659443026
Name:DE JESUS, MARIA DE LOS ANGELES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 AVE MUNOZ RIVERA
Mailing Address - Street 2:EDIFICIO DARLINGTON OFICINA 902
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2724
Mailing Address - Country:US
Mailing Address - Phone:787-315-1389
Mailing Address - Fax:
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO DARLINGTON OFICINA 902
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2724
Practice Address - Country:US
Practice Address - Phone:787-315-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1136103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical