Provider Demographics
NPI:1255528048
Name:DE JESUS, GEORGETTE M (MD)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:M
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 CALLE WILSON
Mailing Address - Street 2:APT 203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2280
Mailing Address - Country:US
Mailing Address - Phone:787-726-0184
Mailing Address - Fax:
Practice Address - Street 1:258 CALLE SAN JORGE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-726-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2446182084P0804X
PR175762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry