Provider Demographics
NPI:1780405365
Name:FLORES DE JESUS, JESMAR (PSYD)
Entity type:Individual
Prefix:
First Name:JESMAR
Middle Name:
Last Name:FLORES DE JESUS
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 AVE SAN IGNACIO
Mailing Address - Street 2:COND SAN IGNACIO APT 2L
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3818
Mailing Address - Country:US
Mailing Address - Phone:787-390-8722
Mailing Address - Fax:
Practice Address - Street 1:22 AVE GONZALEZ GUISTI
Practice Address - Street 2:STE 206
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0000
Practice Address - Country:US
Practice Address - Phone:787-390-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005179103TC0700X
PR005176103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical