Provider Demographics
NPI:1336573153
Name:DE JESUS, VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:DE JESUS
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 1:1955 ULSTER ST
Mailing Address - Street 2:APT. 149
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2065
Mailing Address - Country:US
Mailing Address - Phone:720-270-5709
Mailing Address - Fax:
Practice Address - Street 1:3101 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2203
Practice Address - Country:US
Practice Address - Phone:720-270-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator