Provider Demographics
NPI:1245673532
Name:DE JESUS, JOSE ERNESTO RODRIGUEZ (HBCE CLE CD CBE PTA)
Entity type:Individual
Prefix:
First Name:JOSE ERNESTO
Middle Name:RODRIGUEZ
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:HBCE CLE CD CBE PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1621
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1621
Mailing Address - Country:US
Mailing Address - Phone:787-602-3110
Mailing Address - Fax:
Practice Address - Street 1:CARR 685 KM 2.9
Practice Address - Street 2:BO. TIERRAS NUEVAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-602-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator