Provider Demographics
NPI:1356594964
Name:DE JESUS, GLORIA B (LND,RD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:B
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:LND,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 CALLE EGIPTO
Mailing Address - Street 2:PLAZA DE LA FUENTE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3804
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-756-8907
Practice Address - Street 1:1062 CALLE EGIPTO
Practice Address - Street 2:PLAZA DE LA FUENTE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3804
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-756-8907
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered