Provider Demographics
NPI:1790989804
Name:ROSA DE JESUS, GINETTE (PSYD)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:
Last Name:ROSA DE JESUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS CAOBOS CALLE NOGAL # 2133
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2703
Mailing Address - Country:US
Mailing Address - Phone:787-633-6993
Mailing Address - Fax:
Practice Address - Street 1:EDIF. SAN GERALDO SUITE 207G BO. TIERRA SANTA CARR. 149
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1824103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist