Provider Demographics
NPI:1912160136
Name:DE JESUS-ACOSTA, CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:DE JESUS-ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:610 CALLE MAR INDICO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4517
Mailing Address - Country:US
Mailing Address - Phone:787-362-6810
Mailing Address - Fax:
Practice Address - Street 1:111 AVE MUNOZ RIVERA E
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2630
Practice Address - Country:US
Practice Address - Phone:787-820-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD764862084N0008X, 2084N0400X
PR178962084N0008X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17896OtherMEDICAL LICENSE