Provider Demographics
NPI:1770121154
Name:PALOU DE JESUS, ROBERTO ANDRES
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANDRES
Last Name:PALOU DE JESUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A1 VIA HORIZONTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4460
Mailing Address - Country:US
Mailing Address - Phone:787-529-3473
Mailing Address - Fax:
Practice Address - Street 1:654 MUNOZ RIVERA STE 1124
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4133
Practice Address - Country:US
Practice Address - Phone:787-499-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program