Healthcare Provider Details

I. General information

NPI: 1033868898
Provider Name (Legal Business Name): ANGEL B. AMADEO DE JESUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/26/2022
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA ROSALES G 15
AIBONITO PR
00705
US

IV. Provider business mailing address

VILLA ROSALES G 15
AIBONITO PR
00705
US

V. Phone/Fax

Practice location:
  • Phone: 939-478-6588
  • Fax:
Mailing address:
  • Phone: 787-310-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number022821
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: