Provider Demographics
NPI:1851028708
Name:DE JESUS, VIRGEN SOCORRO
Entity Type:Individual
Prefix:
First Name:VIRGEN
Middle Name:SOCORRO
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGEN
Other - Middle Name:SOCORRO
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:EE5 CALLE 23
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4091
Mailing Address - Country:US
Mailing Address - Phone:787-453-9188
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 185 KM 4.6 CANOVANAS PR 00729
Practice Address - Street 2:4.6 KM
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-453-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR83254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83254OtherRN
PR83254OtherNURSE REGISTER