MEDICARE: MS. MARIAN DE JESUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6668	PR

General Provider Information

NPI Number	:	1275557563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIAN DE JESUS M.D.

Provider Business Mailing Address
First Line	:	EXT VILLAMAR
Second Line	:	1025 CALLE MARGINAL VILLAMAR
City	:	CAROLINA
State	:	PR
Zip	:	00979-6348
Country	:	US
Telephone Number	:	787-726-3901
Fax Number	:	787-268-5838

Provider Business Practice Location Address
First Line	:	EXT VILLAMAR
Second Line	:	1025 CALLE MARGINAL VILLAMAR
City	:	CAROLINA
State	:	PR
Zip	:	00979-6348
Country	:	US
Telephone Number	:	787-726-3901
Fax Number	:	787-268-5838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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