Provider Demographics
NPI:1295952075
Name:DE JESUS CARTAGENA, LORNA L
Entity type:Individual
Prefix:DR
First Name:LORNA
Middle Name:L
Last Name:DE JESUS CARTAGENA
Suffix:
Gender:F
Credentials:
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 71325
Mailing Address - Street 2:SUITE 164
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8425
Mailing Address - Country:US
Mailing Address - Phone:787-706-1344
Mailing Address - Fax:787-793-2308
Practice Address - Street 1:1669 AVE AMERICO MIRANDA
Practice Address - Street 2:URB. LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2429
Practice Address - Country:US
Practice Address - Phone:787-706-1344
Practice Address - Fax:787-793-2308
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13245208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55900Medicare UPIN