Provider Demographics
NPI:1689784795
Name:DE JESUS, NELSON HECTOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:HECTOR
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:8987 E TANQUE VERDE
Mailing Address - Street 2:STE 309-383
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-318-4930
Mailing Address - Fax:520-318-3362
Practice Address - Street 1:1011 N CRAYCROFT RD
Practice Address - Street 2:STE 400
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7313
Practice Address - Country:US
Practice Address - Phone:520-318-4930
Practice Address - Fax:520-318-3362
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0604540OtherBCBS
AZAZ0604540OtherBCBS